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Surgeon Enthusiasm for Spinal Surgery Drives Rates

Significant regional variation in high rates due more to surgeon enthusiasm than other factors

FRIDAY, March 25 (HealthDay News) -- Surgical rates for degenerative diseases of the lumbar spine (DDLS) are mainly affected by surgeon enthusiasm for surgery and not by disease prevalence or community resources, according to a study published in the March 15 issue of Spine.

S. Samuel Bederman, M.D., Ph.D., from the University of California at Irvine in Orange, and colleagues determined the influence of patient, family physician, and surgeon enthusiasm for surgery on the regional variation in surgical rates for DDLS. Standardized utilization rates across counties were calculated for 10,318 patients aged 50 years and older who underwent DDLS surgery from 2002 to 2006. Incidence rate ratios (IRRs) for surgery were measured for patients, family physicians, and surgeons, taking into account disease prevalence, county demographics, socioeconomic measures, and community resources.

The investigators found that there was significant regional variation in surgery rates. Higher rates were seen in regions with higher surgeon enthusiasm for surgery (IRR, 1.26), lower income (IRR, 0.89), increasing age (IRR, 2.17), male gender (IRR, 1.19), more understanding of official languages (IRR, 1.12), and availability of magnetic resonance imaging scanners (IRR, 1.30). Higher surgical rates were not statistically significantly associated with family physician and patient enthusiasm for surgery, physician supply, or disease prevalence.

"Because surgeon enthusiasm appears to be driving surgical rates for DDLS surgery, strategies to understand why surgeons have variable 'enthusiasm' for surgery, despite high-quality evidence for its effectiveness with specific indications (i.e., spinal stenosis and degenerative spondylolisthesis), are needed," the authors write.

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