Private healthcare sector spine surgery: patient and surgeon profiles from a large open medical scheme in South Africa
DOI:
https://doi.org/10.7196/SAMJ.2023.v113i7.291Keywords:
Spine, private sector, orthopaedic surgeon, neurosurgeon, medical schemeAbstract
Background
It is generally understood that the profile of spine surgery varies by setting, based on factors such as the age profile of the population, the economic context and access to healthcare. Relatively little is known about the profile of spine surgery in South Africa, although one previous report from the public healthcare sector suggested a high burden of trauma and infection-related surgery. To our knowledge, there has been no formal investigation in the private sector. A holistic understanding of spine surgery within our setting may be beneficial for applications such as resource allocation and informing the training needs of future specialists.
Objectives
To provide insight into spinal surgery in the South African private healthcare sector by describing spine surgery characteristics within a large open medical scheme, including both patient and surgeon profiles.
Methods
This retrospective review included adult inpatient spine surgeries funded by the largest open medical scheme in South Africa between 2008 and 2017. An anonymized dataset extracted from the scheme records included patient demographics, ICD-10 codes, procedure codes and surgeon specialization. Descriptive patient and surgery data were presented. Furthermore, the association between patient and surgery factors and surgeon specialization was investigated using univariate and multivariate analyses.
Results
A total of 49,576 index spine surgeries were included. The largest proportion of surgeries involved members 40-59 years old (n=23,543, 48%), approximately half involved female members (n=25,293, 51%) and most were performed by neurosurgeons (n=35,439, 72%). At least 37,755 (76%) surgeries were for degenerative pathology, 2,100 (4%) for trauma and 242 (0.5%) for infection. Adjusted risk ratios (aRR) significantly associated with orthopaedic surgeon specialization included cervical spine region aRR = 0.49 (95% C.I. 0.39-0.61), trauma aRR = 1.50 (95% C.I. 1.20-1.88), deformity aRR = 1.77 (95% C.I. 1.33-2.35) and blood transfusion aRR = 1.46 (95% C.I. 1.12-1.91).
Conclusion
Spine surgery in South Africa’s largest open medical scheme was dominated by surgery for degenerative pathology in older adults and was performed largely by neurosurgeons. This constituted a stark contrast to a previous report from the public sector and highlighted a mismatch between exposure during public sector registrar training and private practice post-specialization. The findings support the need for private-public collaboration as well as the importance of spine fellowships for all specialists intending to practice spine surgery.
References
Otani K, Kikuchi S, Yabuki S, et al. Lumbar spinal stenosis has a negative impact on quality of life compared with other comorbidities: An epidemiological cross-sectional study of 1 862 community- dwelling individuals. Scien World J 2013;2013:590652. https://doi.org/10.1155/2013/590652
Sadosky AB, DiBonaventura M, Cappelleri JC, Ebata N, Fujii K. The association between lower back pain and health status, work productivity, and health care resource use in Japan. J Pain Res 2015;2015(8):119-130. https://doi.org/10.2147/JPR.S76649
Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet 2018;391(10137):2356-2367. https://doi.org/10.1016/S0140-6736(18)30480-X
ZainaF,Tomkins-LaneC,CarrageeE,NegriniS.Surgicalversusnon-surgicaltreatmentforlumbarspinal stenosis. Cochr Database Syst Rev 2016;2016(1):CD010264. https://doi.org/10.1002/14651858.CD010264. pub2
Fessler RG. Surgery versus nonsurgery for lumbar spinal stenosis: An in-depth analysis of the 2016 Cochrane analysis, the studies included for analysis, and Cochrane methodology. J Neurosurg Spine 2021;35(5):1-9. https://doi.org/10.3171/2021.1.SPINE201894
Held U, Steurer J, Pichierri G, et al. What is the treatment effect of surgery compared with nonoperative treatment in patients with lumbar spinal stenosis at 1-year follow-up? J Neurosurg Spine 2019;31(2):185- 193. https://doi.org/10.3171/2019.1.SPINE181098
KotkansaloA,LeinonenV,KorajokiM,SalmenkiviJ,KorhonenK,MalmivaaraA.Surgeryfordegenerative cervical spine disease in Finland, 1999 - 2015. Acta Neurochir 2019;161(10):2147-2159. https://doi. org/10.1007/s00701-019-03958-6
XuY,YenD,WhiteheadM,XuJ,JohnsonAP.Useofinstrumentedlumbarspinalsurgeryfordegenerative conditions: Trends and costs over time in Ontario, Canada. Can J Surg 2019;62(6):393-401. https://doi. org/10.1503/cjs.017016
Cram P, Landon BE, Matelski J, et al. Utilisation and outcomes for spine surgery in the United States and Canada. Spine 2019;44(19):1371-1380. https://doi.org/10.1097/BRS.0000000000003083
Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS. Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. Spine 2019;44(5):369-376. https://doi.org/10.1097/BRS.0000000000002822
Waheed MA, Hasan S, Tan LA, et al. Cervical spine pathology and treatment: A global overview. J Spine Surg 2020;6(1):340-350. https://doi.org/10.21037/jss.2020.01.12
KobayashiK,SatoK,KatoF,etal.Trendsinthenumbersofspinesurgeriesandspinesurgeonsoverthepast 15 years. Nagoya J Med Sci 2022;84:155-162. https://doi.org/10.18999/nagjms.84.1.155
Grotle M, Småstuen MC, Fjeld O, et al. Lumbar spine surgery across 15 years: Trends, complications and reoperations in a longitudinal observational study from Norway. BMJ Open 2019;9(8):e028743. https://doi. org/10.1136/bmjopen-2018-028743
Sah HK, Shrestha DK, Rajbhandari B, et al. Profile and outcome of adult spine pathologies managed in a neurosurgical tertiary care center in Nepal. J Inst Med Nepal 2020;42(1):54-58. https://doi.org/10.3126/ JIOM.V42I1.37428
MiseerS,MannΤ,DavisJ.BurdenandprofileofspinalpathologyatamajortertiaryhospitalintheWestern Cape, South Africa. SA Orth Jm2019;18(1):33-39. https://doi.org/10.17159/2309-8309/2019/v18n1a4
Mann TN, Schaaf HS, Dunn RN, et al. Child and adult spinal tuberculosis at tertiary hospitals in the
Western Cape, South Africa: 4-year burden and trend. Epidemiol Infect 2018;146(16):2107-2115. https://
doi.org/10.1017/S0950268818002649
Mkize S, Dunn R. Proximal junctional kyphosis post tuberculous spine corrective surgery in paediatric patients. Spine Deform 2021;9(1):169-174. https://doi.org/10.1007/s43390-020-00186-2
FieggenG.NeurosurgeryinSouthAfrica.SAfrMedJ2014;104(4):254.https://doi.org/10.7196/SAMJ.8213 19. Discovery Health Medical Scheme. Results highlights for the six months ended 31 December 2017. Cape Town: DHMS, 2017. https://www.discovery.co.za/medical-aid/annual-reports-and-financials (accessed 11
October 2022).
Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-
CM and ICD-10 administrative data. Med Care 2005;43(11):1130-1139. https://doi.org/10.1097/01.
mlr.0000182534.19832.83
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987;40(5):373-383. https://doi. org/10.1016/0021-9681(87)90171-8
Daniels AH, Ames CP, Smith JS, Hart RA. Variability in spine surgery procedures performed during orthopaedic and neurological surgery residency training: An analysis of ACGME case log data. J Bone Joint Surg Am 2014;96(23):e196. https://doi.org/10.2106/JBJS.M.01562
Malempati H, Wadey VMR, Paquette S, et al. Spinal surgery fellowship education in Canada: Evaluation of trainee and supervisor perspectives on cognitive and procedural competencies. Spine 2013;38(1):83-91. https://doi.org/10.1097/BRS.0B013E3182640F69
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