Variations in Surgical Appropriateness for Spine Surgery New Patient Consultations: Analysis of Referral Patterns and Patient Characteristics.

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

Co-Author(s)

KA

Kasra Araghi, BS

Research Fellow
Hospital for Special Surgery
Scottsdale, Arizona, United States

Presenting Author (Person doing the Podium Present(s)

TS

Tejas Subramanian, BS

Hospital for Special Surgery, United States

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Co-Author(s)

NH

Nawaal Haque

Hospital for Special Surgery, United States
OM

Omri Maayan, BS

Hospital for Special Surgery, United States
RM

Robert Merrill, MD

Hospital for Special Surgery, United States
PS

Pratyush Shahi, MBBS

Hospital for Special Surgery
New York, New York, United States
TA

Troy Amen, MD, MBA

Hospital for Special Surgery, United States
AP

Anthony Pajak, BS

Hospital for Special Surgery, United States
OT

Olivia Tuma, BS

Hospital for Special Surgery
New York, New York, United States
MK

Maximillian Korsun, BS

Hospital for Special Surgery, United States
JC

John Clohisy, MD

Hospital for Special Surgery, United States
BZ

Bo Zhang, MD

United States
JD

Jerry Du, MD

Hospital for Special Surgery, United States
ES

Evan Sheha, MD

Hospital for Special Surgery, United States
JD

James E. Dowdell, MD

Spine Fellow
Hospital for Special Surgery
New York, New York, United States
SI

Sravisht Iyer, MD

Assistant Attending, Spine Surgery
Hospital for Special Surgery
New York, New York, United States
SQ

Sheeraz A. Qureshi, MD, MBA

Attending Surgeon
Hospital for Special Surgery
York, New York, United States

Submitter(s)

HS

HSS SpineTeam

New York, New York, United States

Disclosure(s):

Tejas Subramanian, BS: No financial relationships to disclose

Omri Maayan, BS: No financial relationships to disclose

Robert Merrill, MD: No financial relationships to disclose

Anthony Pajak, BS: No financial relationships to disclose

John Clohisy, MD: No financial relationships to disclose

Sravisht Iyer, MD: No financial relationships to disclose

Introduction
While indications for patients appropriate for spinal surgery are well-defined, surgeons encounter many patients who are not surgically indicated or have not attempted conservative management. Over-referrals can result in long wait times, delayed care, worse outcomes, and resource waste. Therefore, appreciating the demographics of patient referrals from different sources and patients more likely to undergo surgery can provide valuable triage information, reducing burdens and improving outcomes.

Aims/Objectives
Identify the demographics of patient referrals from various referral sources and examine referral patterns to identify if certain factors influence patients’ surgical likelihood.
Methods
All new patients age ≥ 18 seen in clinic by 8 spine surgeons between 2018 and 2021 were analyzed. Referral type was designated as Self-referral, MSK, or Non-MSK. Patient demographics extracted include age, BMI, zip code (proxy for SES), sex, race, insurance type, and surgical procedures undergone within 1.5 years post-clinic visit. ANOVA and a Kruskal Wallis Test was used to compare means among normally and non-normally disturbed groups, respectively. A chi-square test was used to compare categorical variables. A multivariable logistic regression model used undergoing surgery as the dependent variable, with several different demographic characteristics as independent predictor variables. Significance was assessed at p< 0.05.

Results
9356 patients were identified with an average of 56 ± 16 years - 84% were self-referred, while 3% and 13% were non-MSK and MSK, respectively. Referral type was found to be a statistically significant predictor of ultimately undergoing surgery, with an odds ratio (OR) of 1.4 for MSK referral relative to non-MSK referral. Independent predictors of undergoing surgery included older age (p=0.0018), higher BMI (p < 0.0001), high-income quartile (p < 0.0001), and male sex (p=0.0246).

Conclusions
MSK providers refer more appropriate patients, yet all spine surgeons encounter patients inappropriate for surgical intervention. Understanding these factors and patterns is critical for improving triage strategies and reducing the burdens of inappropriate referrals for all stakeholders.