Appropriateness Criteria May Improve Surgical Outcomes

Application is associated with improved outcomes in patients with low back pain and/or sciatica
By Rick Ansorge
HealthDay Reporter

FRIDAY, April 2 (HealthDay News) -- In patients with low back pain and/or sciatica, application of appropriateness criteria for surgery can significantly improve patient outcomes, according to a study in the March 15 issue of Spine.

Nadia Danon-Hersch, M.D., of the University of Lausanne in Switzerland, and colleagues conducted a prospective study based on appropriateness criteria for low back surgery developed by a multi-specialty panel using the RAND appropriateness method, and compared one-year outcomes in 365 patients who received treatment considered appropriate and 33 patients who received treatment considered inappropriate.

Compared to inappropriate treatment, the researchers found that appropriate treatment was associated with significantly higher mean improvements in the health-related-quality of life (SF-36) physical component score (12.3 versus 6.8 points), SF-36 mental component score (5.0 versus −0.5 points), visual analog scale back pain score (2.3 versus 0.8 points), and Roland-Morris disability score (7.7 versus 4.2 points). The appropriate-treatment group also had a higher improvement in the mean visual analog scale score for sciatica than the inappropriate-treatment group (4.0 versus 2.8 points), but the difference was not significant.

"Before wider dissemination, these appropriateness criteria should be updated to take into account current state of the art," the authors write. "Further, larger studies involving different study populations should be carried out to evaluate the more long-term effect of the use of appropriateness criteria on various outcome dimensions."

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