Surgeons preference for lumbar disk surgery: a discrete choice experiment
European Spine Journal, vol. 31, pp. 380–388
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.
Authors 5
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Pravesh Shankar Gadjradj corresponding
Affiliation as printed
Department of Neurosurgery, Park MC, Hoofdweg 90, Rotterdam, the Netherlands. p.gadjradj@erasmusmc.nl
Department of Neurosurgery, Park MC, Hoofdweg 90, Rotterdam, the Netherlands
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Affiliation as printed
Department of Neurosurgery, Erasmus MC: University Medical Center Rotterdam, Rotterdam, the Netherlands
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Amsterdam Movement Sciences · Vrije Universiteit Amsterdam
Affiliation as printed
Department Movement Sciences, Faculty Behavioral and Movement Sciences and, Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, the Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
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Affiliation as printed
Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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