A retrospective analysis of patients deemed ineligible for surgery in a multidisciplinary complex spine conference

Assess patient experiences and outcomes following a multidisciplinary conference recommendation against surgery, including the proportion who later pursued surgery elsewhere and their outcomes.

We performed a retrospective analysis of patients advised against surgery during our internal multidisciplinary ASD conference. A phone-based survey gathered on patient satisfaction, effectiveness of alternative treatments, rates of operations at outside hospitals, and subsequent rates of complications, reoperations, and readmissions among those who underwent surgery.

One hundred one patients had an evaluation by a multidisciplinary conference from 2015 to 2024 with an initial recommendation against surgery; 9 later met surgical criteria and underwent surgery with our group, while 17 died before this study. Of the remaining 75, 2 were unable to participate due to medical reasons, and 33 were unreachable, leaving 40 survey participants. Nine declined to answer, and thirty-one completed the survey. Among respondents, 71% were satisfied with the recommendation against surgery, and 38.7% sought a second opinion. Of those, 41.7% (5/12) were recommended surgery, and 33% (4/12) underwent surgery elsewhere with minimal complications. Most respondents rated their quality of life as 'acceptable' and used physical therapy and pain management for symptom control.

While most patients were satisfied with our recommendation against surgery, a notable subset sought second opinions, and some ultimately underwent successful surgery. These findings highlight the need for periodic reassessment of multidisciplinary conference criteria to ensure optimal patient outcomes.