Presurgical physician utilization in elective thoracolumbar spine surgery candidates: a nationwide analysis from the CSORN database

Background: Our objective was to assess the frequency of physician utilization in spine surgery candidates in the 6 months before surgical booking, and present differences by region. Methods: We conducted a retrospective analysis of prospectively collected data from the Canadian Spine Outcomes and Research Network (CSORN). Twelve spine surgery sites across Canada contributed data for spine surgery candidates from 2008 to 2014. Patients (n = 537) had degenerative spinal pathology or deformity of the thoracolumbar region. Frequencies of physician visits (excluding the attending spine surgeon) were tabulated to estimate some of the health care utilization consumed by spine surgery candidates before surgeon consultation. Results: Patients reported 1-2 ician 572 times, 3-10 visits 366 times, and 10 or more visits 81 times. This equals at least 2561 visits, and a conservative maximum (if > 10 = 11) of 5695 visits. Not surprisingly, family doctors accounted for the most visits and naturopaths the fewest. Consultations with another spine surgeon represented the second-highest utilization; this doctor shopping was most prevalent in Ontario (p < 0.05). Analysis by region revealed twice as many emergency department visits in Saint John as in Vancouver. Saint John and Vancouver had significantly fewer pain management visits than other sites, and Quebec had significantly fewer family doctor visits (p < 0.05). For patient-reported disability (Oswestry Disability Index; ODI), patients who never saw an emergency physician reported significantly less disability than those who saw an emergency physician (p < 0.05). There were no differences in baseline ODI for other spine surgeon, rheumatologist, family doctor, naturopath or other. Patients who never saw a pain management specialist reported significantly less disability than those who saw one more than 10 times (p < 0.05). There were no differences in baseline pain ratings or health score for those who went to another physician, with the exception of family doctors; those with more than 10 visits had higher baseline leg pain and lower health scores (p < 0.05). Conclusion: Given the similarities in baseline characteristics pertaining to pain, disability and health state in this study, spine patient utilization of physician resources is high and variable. A focused strategy to provide appropriate, targeted care to spine patients is needed across Canada. Future research should investigate the impact of spine triage systems on