Physical medicine and rehabilitation and interdisciplinary spine clinic referrals are associated with increased conversion to spine surgery.

Abstract

Background: Currently, in the United States, many patients receive immediate referral to a spine surgeon upon concern for any spine pathology, prior to undergoing conservative management. However, research has demonstrated that referrals to spine surgeons for common problems such as low back pain are often not indicated. This situation leads to inefficient care, delayed conservative treatments, and longer wait times for available surgical consultations. Therefore, this highlights an opportunity to improve efficiency in care for patients and clinicians through proper triaging for spine surgery.

Objective: To examine whether clinicians from physical medicine and rehabilitation (PM&R) and nonsurgical interdisciplinary spine clinics effectively triaged patients for spine surgeon evaluations.

Design: Retrospective study (May 2022-April 2023) of consecutive new patients referred to a spine surgery clinic. Charts were evaluated to determine if surgery was indicated at the initial spine surgeon evaluation. The proportion of patients indicated for surgery was calculated based on the source of referral. An odds ratio (OR) of patients indicated for surgery was calculated to compare different specialty groupings.

Setting: All new consecutive patients evaluated between May 2022 and April 2023 on the panels of two fellowship-trained orthopedic spine surgeons at a single outpatient clinic in the Pacific Northwest United States were included. Patients whose symptoms were associated with infections, trauma, and tumors were also excluded as these patients typically have elevated clinical acuity.

Results: Of 503 patients, 247 (49.1%) were indicated for and underwent spine surgery within 6 months of initial evaluation. PM&R referrals were more likely to result in surgery compared to primary care physician referrals (OR, 2.88 [95% CI, 1.73-4.79]). Patients referred from interdisciplinary spine clinics were also more likely to undergo surgery compared to those referred by a primary care physician (OR, 2.36 [95% CI, 1.56-3.57]) or generalists (OR, 2.37 [95% CI, 1.58-3.57]).

Conclusion: Referrals from PM&R and interdisciplinary spine clinics were significantly associated with increased odds of being indicated for surgery at the time of initial evaluation with a spine surgeon. These findings highlight how interdisciplinary efforts may reduce the nonoperative consultations seen by surgical spine clinicians.