Indication for spinal surgery: associated factors and regional differences in Germany.

Area of Science:

• Health Services Research
• Epidemiology
• Orthopedic Surgery

Background:

• Increasing rates of spinal surgery necessitate investigation into its indications.
• Patient and regional factors influencing spinal surgery decisions require detailed analysis.

Purpose of the Study:

• To investigate patient-level and regional factors associated with spinal surgery for patients with spinal diseases.
• To understand the drivers behind regional heterogeneity in spinal surgery rates.

Main Methods:

• A large-scale cohort study utilizing routine German healthcare data (2008-2016).
• Analysis of 18.4 million patients and 60.9 million episodes using a Poisson model.
• Inclusion of sociodemographic, morbidity, social status, disease-related, and healthcare-related variables.

Main Results:

• Significant regional variation in spinal surgery occurrence was observed, with only a quarter reduction after controlling for assessed determinants.
• Musculoskeletal and mental health disorders, along with physical therapy, correlated with decreased surgery probability.
• Pain medication prescriptions and specialist consultations were associated with increased surgery probability, yet disease severity was not assessed.

Conclusions:

• A significant portion of regional heterogeneity in spinal surgery rates remains unexplained by measured factors, suggesting the influence of unmeasured variables like physician preferences.
• The study highlights patterns in spinal disease care and their association with surgery probability in Germany.
• A notable percentage of patients undergoing surgery lacked prior specialist consultation, diagnostics, or physical therapy.