DALHOUSIE UNIVERSITY SPINE DATABASE: PROSPECTIVE ANALYSIS OF DISABILITY, PAIN, DEPRESSION, AND PATIENT-PERCEIVED INFLUENCE OF REFERRAL DELAY ON OUTCOME

Abstract

The referral time for spine surgery consultation in Halifax is approximately one year. We currently do not understand the significance of delay in surgical consultation, nor do we have documentation of patient-perceived effects of this delay. Identifying patient characteristics associated with spine pathology mandating earlier surgical intervention would have obvious benefit in streamlining this population in our referral pattern. Furthermore, outlining patient characteristics who are unlikely to benefit from orthopaedic surgical assessment for spine surgery may facilitate community management of spinal pathology and accordingly improve wait times for surgical consultation.

The aim of this study was to Identify patient variables that are predictive of need for early surgical evaluation. Also, to assess patient and surgeon satisfaction with wait times for consultation.

Demographic data and questionnaires were prospectively collected on all consenting patients seen by two orthopaedic spine surgeons over a two week period. Patient and surgeon impression of wait was documented, in addition to Oswestry Disability Index (ODI) scores, and the Visual Analogue Scale (VAS) to document pain. Surgeon reasons for scheduling or delaying surgical planning were also documented and correlated to patient scores.

The average wait time for surgical consultation was 9.7 months, with a mode of sixteen months. 62.8% of patients felt that earlier consultation would be more appropriate, while 31.1% felt that they had deteriorated due to the delay. In addition, 26% felt that the delay negatively influenced their prognosis. Treating surgeons felt that the patient should have been seen sooner in 39% of cases, and that delay in consultation negatively affected prognosis in 6.2% of cases. Of two hundred and forty-two patients completing the survey over the two week period, only ten (4.1%) were scheduled for surgery.

Both patients and physicians felt that prolonged referral-consultation wait times were unacceptable, and deleteriously affected prognosis in a significant proportion of cases. The majority of patients seen were not deemed surgical candidates, indicating room for improvement in referral patterns.