A retrospective analysis of patients deemed ineligible for surgery in a multidisciplinary complex spine conference.

Purpose: Assess patient experiences and outcomes following a multidisciplinary conference recommendation against surgery, including the proportion who later pursued surgery elsewhere and their outcomes.

Methods: We performed a retrospective analysis of patients advised against surgery during our internal multidisciplinary ASD conference. A phone-based survey gathered on patient satisfaction, effectiveness of alternative treatments, rates of operations at outside hospitals, and subsequent rates of complications, reoperations, and readmissions among those who underwent surgery.

Results: One hundred one patients had an evaluation by a multidisciplinary conference from 2015 to 2024 with an initial recommendation against surgery; 9 later met surgical criteria and underwent surgery with our group, while 17 died before this study. Of the remaining 75, 2 were unable to participate due to medical reasons, and 33 were unreachable, leaving 40 survey participants. Nine declined to answer, and thirty-one completed the survey. Among respondents, 71% were satisfied with the recommendation against surgery, and 38.7% sought a second opinion. Of those, 41.7% (5/12) were recommended surgery, and 33% (4/12) underwent surgery elsewhere with minimal complications. Most respondents rated their quality of life as 'acceptable' and used physical therapy and pain management for symptom control.

Conclusion: While most patients were satisfied with our recommendation against surgery, a notable subset sought second opinions, and some ultimately underwent successful surgery. These findings highlight the need for periodic reassessment of multidisciplinary conference criteria to ensure optimal patient outcomes.