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Multidisciplinary Evaluation Leads to the Decreased Utilization of Lumbar Spine Fusion

An Observational Cohort Pilot Study

Yanamadala, Vijay, MD, MBA∗,†,‡; Kim, Yourie, RN, BSN∗,§; Buchlak, Quinlan D., MPsych; Wright, Anna K., PhD; Babington, James, MD∗,§; Friedman, Andrew, MD∗,§; Mecklenburg, Robert S., MD; Farrokhi, Farrokh, MD∗,†; Leveque, Jean-Christophe, MD∗,†; Sethi, Rajiv K., MD∗,†,||

doi: 10.1097/BRS.0000000000002065
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Study Design. Observational cohort pilot study.

Objective. To determine the impact of a multidisciplinary conference on treatment decisions for lumbar degenerative spine disease.

Summary of Background Data. Multidisciplinary decision making improves outcomes in many disciplines. The lack of integrated systems for comprehensive care for spinal disorders has contributed to the inappropriate overutilization of spine surgery in the United States.

Methods. We implemented a multidisciplinary conference involving physiatrists, anesthesiologists, pain specialists, neurosurgeons, orthopaedic spine surgeons, physical therapists, and nursing staff. Over 10 months, we presented patients being considered for spinal fusion or who had a complex history of prior spinal surgery. We compared the decision to proceed with surgery and the proposed surgical approach proposed by outside surgeons with the consensus of our multidisciplinary conference. We also assessed comprehensive demographics and comorbidities for the patients and examined outcomes for surgical patients.

Results. A total of 137 consecutive patients were reviewed at our multidisciplinary conference during the 10-month period. Of these, 100 patients had been recommended for lumbar spine fusion by an outside surgeon. Consensus opinion of the multidisciplinary conference advocated for nonoperative management in 58 patients (58%) who had been previously recommended for spinal fusion at another institution (χ2 = 26.6; P < 0.01). Furthermore, the surgical treatment plan was revised as a product of the conference in 28% (16 patients) of the patients who ultimately underwent surgery 2 = 43.6; P < 0.01). We had zero 30-day complications in surgical patients.

Conclusion. Isolated surgical decision making may result in suboptimal treatment recommendations. Multidisciplinary conferences can reduce the utilization of lumbar spinal fusion, possibly resulting in more appropriate use of surgical interventions with better candidate selection while providing patients with more diverse nonoperative treatment options. Although long-term patient outcomes remain to be determined, such multidisciplinary care will likely be essential to improving the quality and value of spine care.

Level of Evidence: 3

Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA

Department of Neurosurgery, Virginia Mason Medical Center, Seattle, WA

Department of Neurosurgery, Massachusetts General Hospital, Boston, MA

§Department of Physical Medicine and Rehabilitation, Virginia Mason Medical Center, Seattle, WA

Department of Medicine, Virginia Mason Medical Center, Seattle, WA

||Department of Health Services, University of Washington, Seattle, WA.

Address correspondence and reprint requests to Rajiv K. Sethi, MD, Neuroscience Institute, Virginia Mason Medical Center, 1100 Ninth Ave, Seattle, WA 98101; E-mail: rajiv.sethi@virginiamason.org

Received 12 August, 2016

Revised 28 November, 2016

Accepted 5 December, 2016

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

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