Rates, Predictive Factors, and Adverse Outcomes of Fusion Surgery for Lumbar Degenerative Disorders in Ontario, Canada, Between 2006 and 2015: A Retrospective Cohort Study.

BACKGROUND: The addition of fusion surgery to the decompression for lumbar degenerative disorders remains controversial. The purpose of this study is to compare the rate and outcome of decompression and fusion versus decompression alone. METHODS: This population-based retrospective cohort study used several linked administrative databases to identify patients who underwent spinal decompression surgery in Ontario, Canada, from 2006 to 2015. Patients who had previous spine surgery, concurrent lumbar disc replacement, or a diagnosis other than degenerative disc disease were excluded. Adjusted logistic regression was used to assess our outcomes. RESULTS: We identified 33,912 patients, of whom 9748 (28.74%) underwent fusion. Overall, fusion rates increased from 27.66% to 31.33% over the study period (P = 0.025). Factors associated with fusion included: older age, female sex, American Society of Anesthesiologists score ≥3, previous total joint replacement, and surgery by an orthopedic surgeon. Fusion surgery was associated with increased odds of 30-day mortality (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.01-3.09; P = 0.046), 30-day (OR 1.94, 95% CI 1.53-2.46; P < 0.0001) and 90-day reoperation (OR 1.66, 95% CI 1.35-2.05; P < 0.0001), and 30-day readmission (OR 1.23, 95% CI 1.02-1.49; P = 0.027) when adjusting for confounding variables. The odds of suffering a complication after fusion and decompression surgery vs. decompression surgery alone were 4.3-fold greater (95% CI 3.78-5.09; P < 0.0001). CONCLUSIONS: As compared with decompression alone, spinal fusion for degenerative lumbar disorders is associated with increased odds of adverse outcomes. These findings highlight the need for spine surgeons to consider carefully their indications for fusion procedures in the setting of degenerative spinal disorders.

The impact of the 6-month waiting target for elective surgery: a patient record study.

AIM: To quantify the number of patients declined surgery due to scoring below the financial threshold, when presenting for total hip or total knee arthroplasty at two New Zealand District Health Boards (DHBs). METHOD: Data from patients presenting with hip or knee osteoarthritis at both Whangarei Base Hospital and Hawke's Bay Regional Hospital from June 2012 to June 2013 were reviewed. Data were taken from hospital codes and patient records. The outcome from clinic visits were recorded as well as the patient's New Zealand Orthopaedic Association (NZOA) prioritisation score. RESULTS: A total of 1202 patient records were reviewed: 393 from Whangarei Base Hospital and 809 from Hawke's Bay Regional Hospital. Of the 858 patients where surgery was both desired by the patient and deemed appropriate by the surgeon, 307 (36%) were declined for being below the financial threshold. These patients had a mean NZOA score of 66.42. At Whangarei Base Hospital, 300 patients were referred for surgery and 98 (33%) were declined for being below threshold. The mean NZOA score was significantly higher in the patients booked for surgery (M=70.62) compared with those declined below threshold (M=55.39, p<0.001). Of the 497 patients referred for arthroplasty at Hawke's Bay Regional Hospital, 205 (41%) were declined for being below threshold. The mean NZOA prioritisation scores were also significantly higher in the patients booked for surgery (M=76.96) compared to those declined (M=64.66; p less than or equal to 0.001). CONCLUSION: 36% of patients who were suitable for hip or knee arthroplasty were declined elective surgery for being below threshold. Many of these patients have significant pain and disability.

The New Zealand Vocational Trainee 2011 Survey: a national snapshot of vocational training.

AIM: To assess the opinions of New Zealand vocational trainees about the quality of their training. METHOD: We surveyed New Zealand vocational trainees using an online questionnaire based on the Australian Medical Association Specialist Trainee Survey, in September and October 2011. RESULTS: The response rate was 24.8% with representation across training programs. Trainees expressed a high level of satisfaction with most aspects of their training, and results compare favourably with Australia. Access to training in the private sector, and value for money emerged as areas of concern, but also highlight the importance of reimbursed costs in the satisfaction of New Zealand trainees. Work life balance is of increasing importance to young doctors, and an unmet desire for extended leave from medical practice may present an issue for workforce capacity and training flexibility in years to come. CONCLUSION: This survey provides a snapshot and a baseline, for future comparisons.