Does a Multidisciplinary Triage Pathway Facilitate Better Outcomes After Spine Surgery

STUDY DESIGN Single-centre prospective non-randomised matched cohort comparison. OBJECTIVE To compare elective lumbar spine surgery outcomes for cases triaged through a multidisciplinary spine pathway versus conventional referral processes. SUMMARY OF BACKGROUND DATA Many health care systems have facilitated low back pain (LBP) guidelines into primary care practice by creating local or regional "pathways" with the goal of enhanced quality of care, improved patient satisfaction and optimal resource utilization, particularly for imaging and surgery. Few comparative outcomes exist for LBP pathways, particularly for surgical outcomes. METHODS One-hundred-fifty patients (SSP group n = 75; conventional group n = 75) undergoing elective lumbar surgery for degenerative conditions between 2011 and 2016 were analyzed with 1-year follow-up. Patient self-reported outcomes included the Oswestry disability index (ODI), visual analogue pain scores (VAS) for back and leg, and EuroQol Group 5 -Dimension self-report (EQ5D). We also assessed baseline clinical features, indications for surgery, therapies received prior to surgery, type of surgery, wait times, and overall patient satisfaction. RESULTS The groups had equivalent baseline demographics, body mass index, Saskatchewan Spine Pathway (SSP) classification of pain pattern, pain scores, functional scores, quality of life scores, indication for surgery, and type of surgery (instrumented or non-instrumented). There was no difference with respect to wait times to see the surgeon or for surgery. Wait time for magnetic resonance imaging (MRI) was significantly shorter for the SSP group (16.8 vs. 63.0 days, p < 0.001). Patients triaged through the SSP were significantly more likely to utilize multiple non-operative treatment strategies prior to seeing the surgeon (p < 0.04). Patient satisfaction was significantly higher for SSP patients prior to surgical assessment (p = 0.03) but did not differ between groups after surgery. CONCLUSION The SSP facilitates significantly shorter wait times for MRI and promotes non-operative treatment strategies. Preoperative patient satisfaction is significantly higher among SSP patients, but there were no significant differences in surgical outcomes. LEVEL OF EVIDENCE 3.