Defensive Medicine in U.S. Spine Neurosurgery. Issue 3 (February 2017)

• Record Type: Journal Article
• Authors: Din, Ryan S.; Yan, Sandra C.; Cote, David J.; Acosta, Michael A.; Smith, Timothy R.
• Is Part Of: Spine. Volume 42:Issue 3(2017)
• Page Start: 177
• Page End: 185
• Publication Date: 2017-02
• Subjects: assurance behavior -- avoidance behavior -- costs -- defensive medicine -- high-risk procedures -- liability -- malpractice -- medical-legal environment -- multivariate analysis -- national survey -- spine neurosurgery; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000001687
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: Observational cross-sectional survey. Objective: To compare defensive practices of U.S. spine and nonspine neurosurgeons in the context of state medical liability risk. Summary of Background Data: Defensive medicine is a commonly reported and costly phenomenon in neurosurgery. Although state liability risk is thought to contribute greatly to defensive practice, variation within neurosurgical specialties has not been well explored. Methods: A validated, online survey was sent via email to 3344 members of the American Board of Neurological Surgeons. The instrument contained eight question domains: surgeon characteristics, patient characteristics, practice type, insurance type, surgeon liability profile, basic surgeon reimbursement, surgeon perceptions of medical legal environment, and the practice of defensive medicine. Results: The overall response rate was 30.6% (n = 1026), including 499 neurosurgeons performing mainly spine procedures (48.6%). Spine neurosurgeons had a similar average practice duration as nonspine neurosurgeons (16.6 vs 16.9 years, P = 0.64) and comparable lifetime case volume (4767 vs 4, 703, P = 0.71). The average annual malpractice premium for spine neurosurgeons was similar to nonspine neurosurgeons ($104, 480.52 vs $101, 721.76, P = 0.60). On average, spine neurosurgeons had a significantly higher rate of ordering labs, medications, referrals, procedures, and imaging solely for liability concerns compared with nonspine neurosurgeons (89.2% vs 84.6%, P = 0.031). Multivariate analysis revealed that spine neurosurgeons were roughly 3 times more likely to practice defensively compared with nonspine neurosurgeons (odds ratio, OR = 2.9, P = 0.001) when controlling for high-risk procedures (OR = 7.8, P < 0.001), annual malpractice premium (OR = 3.3, P = 0.01), percentage of patients publicly insured (OR = 1.1, P = 0.80), malpractice claims in the last 3 years (OR = 1.13, P = 0.71), and state medical-legal environment (OR = 1.3, P = 0.37). Conclusion: State-based medical legal environment is not a significant driver of increased defensive medicine associated with neurosurgical spine procedures. Level of Evidence: 3