Published online Jul 18, 2015. doi: 10.5312/wjo.v6.i6.483
Peer-review started: February 27, 2015
First decision: April 27, 2015
Revised: May 20, 2015
Accepted: June 1, 2015
Article in press: June 2, 2015
Published online: July 18, 2015
Processing time: 138 Days and 18.2 Hours
AIM: To ascertain current surgeon practice in the United Kingdom National Health Service for the management of patients undergoing lumbar spinal fusion surgery.
METHODS: Descriptive survey methodology utilised an online questionnaire administered through SurveyMonkey. Eligible participants were all surgeons currently carrying out lumbar spinal fusion surgery in the National Health Service. Two previous surveys and a recent systematic review informed questions. Statistical analyses included responder characteristics and pre-planned descriptive analyses. Open question data were interpreted using thematic analysis.
RESULTS: The response rate was 73.8%. Most surgeons (84%) were orthopaedic surgeons. Range of surgeon experience (1-15 years), number of operations performed in the previous 12 mo (4-250), and range of information used to predict outcome was broad. There was some consistency of practice: most patients were seen preoperatively; all surgeons ensured patients are mobile within 3 d of surgery; and there was agreement for the value of post-operative physiotherapy. However, there was considerable variability of practice: variability of protocols, duration of hospital stay, use of discharge criteria, frequency and timing of outpatient follow up, use of written patient information and outcome measures. Much variability was explained through patient-centred care, for example, 62% surgeons tailored functional advice to individual patients.
CONCLUSION: Current United Kingdom surgeon practice for lumbar spinal fusion is described. The surgical procedure and patient population is diverse, and it is therefore understandable that management varies. It is evident that care should be patient-centred. However with high costs and documented patient dissatisfaction it is important that further research evaluates optimal management.
Core tip: This study surveyed all surgeons carrying out lumbar spinal fusions in the United Kingdom (response rate 73.8%) to ascertain current practice. Eighty-four percent of participants were orthopaedic surgeons and their experience of lumbar spinal fusion ranged from 1-15 years, each performing 4-250 operations in the previous 12 mo. Surgeons consistently saw patients preoperatively, ensured patients are mobile within 3 d of surgery, and valued post-operative physiotherapy. However, variability of protocols, duration of hospital stay, use of discharge criteria, frequency and timing of outpatient follow up, use of written patient information and outcome measures was considerable. Much variability was explained through patient-centred care.