Surgeons preference for lumbar disk surgery: a discrete choice experiment

Abstract

Purpose Multiple surgical techniques are practiced to treat sciatica caused by lumbar disk herniation. It is unknown which factors surgeons find important when offering certain surgical techniques. The objective of this study is threefold: 1) determine the relative weight surgeons place on various characteristics of sciatica treatment, 2) determine the trade-offs surgeons make between these characteristics and 3) identify preference heterogeneity for sciatica treatment. Methods A discrete choice experiment was conducted among members of two international neurosurgical organizations. Surgeons were asked on their preferences for surgical techniques using specific scenarios based on five characteristics: effectiveness on leg pain, risk of recurrent disk herniation, duration of postoperative back pain, risk of complications and recovery period. Results Six-hundred and forty-one questionnaires were filled in, the majority by neurosurgeons. All characteristics significantly influenced the preferences of the respondents. Overall, the risk of complications was the most important characteristic in the decision to opt-in or opt-out for surgery (35.7%). Risk of recurrent disk herniation (19.6%), effectiveness on leg pain (18.8%), postoperative back pain duration (13.5%) and length of recovery period (12.4%) followed. Four latent classes were identified, which was partly explained by the tenure of the surgeon. Surgeons were willing to trade-off 57.8% of effectiveness on leg pain to offer a treatment that has a 1% complication risk instead of 10%. Conclusion In the context of this discrete choice experiment, it is shown that neurosurgeons consider the risk of complications as most important when a surgical technique is offered to treat sciatica, while the risk of recurrent disk herniation and effectiveness are also important factors. Neurosurgeons were prepared to trade off substantial amounts of effectiveness to achieve lower complication rates.

Patient preferences for treatment of lumbar disc herniation: a discrete choice experiment

“…For instance, in general proposed advantages of minimally invasive surgery are the ability to perform the technique on an outpatient basis and the increased likelihood of a shorter recovery period, smaller scar size, and lower rate of postoperative back pain compared with open surgery, among others. 13 In this study, patients preferred hospitalization and did not necessarily seem to be influenced in their choices by the size of the scar. These results imply that a shared decision should be made by the patient and neurosurgeon based on a discussion of surgical characteristics with patients, and that not all patients would prefer minimally invasive surgery.…”

“…Aside from the lack of evidence in favor of tubular discectomy and PELD, previous research has shown that the risk of complications, the risk of recurrent disc herniation, and the effect on leg pain were the most important factors in deciding which surgical procedure is offered by surgeons. 13 Aside from the surgeons' preferences in offering certain techniques to treat sciatica, patients' own preferences might also play an important role in determining the procedure they will undergo. Currently it is unknown which characteristics of the different surgical techniques (e.g., size of the scar, ability to undergo surgery under local anesthesia) determine the preferences patients have for elective surgery for sciatica.…”

“…In a previous DCE among 641 surgeons, preferences in offering lumbar discectomy were measured. 13 In that analysis, surgeons deemed the risk of complications to be of the most importance, followed by the risk of recurrent disc herniation, effect on leg pain, postoperative back pain du- ration, and length of the recovery period. In the DCE study reported here, risk of complications, risk of recurrent disc herniation, and the postoperative duration of back pain did not receive a high enough ranking by patients to be included as attributes.…”

Modeling Optimal Clinical Thresholds for Elective Abdominal Hernia Repair in Patients With Cirrhosis

“…These results imply that currently perceived thresholds for acceptable surgical risk are lower than estimated by our decision model and should justifiably be shifted toward higher MELD-Na values. Risk averse behavior by clinicians and patients is not surprising, as fear of the unknown has been demonstrated to influence decision-making in other clinical scenarios . Models, such as those presented here, can help clinicians and patients to make more informed decisions.…”

“…Risk averse behavior by clinicians and patients is not surprising, as fear of the unknown has been demonstrated to influence decision-making in other clinical scenarios. [30][31][32] Models, such as those presented here, can help clinicians and patients to make more informed decisions.…”