6 Ways Evidence-Based Medicine Impacts Orthopaedic and Spine Surgery

Posted by: admin on: June 19, 2011

With the advent of computer, data entry, its analysis & storage have all become easier than ever before. Recording the treatment given and the results obtained could be of great benefit to the medical fraternity. This is what the orthopaedic fraternity has to say.


“As orthopaedic surgeons, we should welcome the opportunity to evaluate what we do and demonstrate it’s effectiveness.”  Say Orthopaedic surgeons from around the country and discuss six important issues surrounding evidence-based medicine and how the focus will impact orthopaedics in the future

1.What evidence-based medicine could contribute. There are many potential benefits of focusing on evidence-based medicine. High-level studies can help orthopaedic surgeons prove their treatments are effective and identify treatments or procedures that aren’t.

The data is a big help for recommending treatment protocols when the physician has to make an ambiguous call due to conflicting or multiple diagnoses”  Surgeons could also use that evidence to better explain to a patient that a treatment may not be completely effective because of their co morbidities. Now we can show them the objective data on patients with similar co morbidities and that helps the patient understand that other health conditions may be part of the problem and could affect the outcome of their treatment.”

2.Impact on technology and device markets.  Orthopaedic surgeons are constantly looking for ways to improve technologies and procedures, but these innovations usually come at an increased cost. Many orthopaedists are now employing minimally invasive surgical techniques, which often require expensive systems and instrumentation. Some of this innovation may not be cost-effective for the surgeon due to low reimbursement rates or to patients due to lack of evidence supporting the technology’s value over other treatment methods or procedures. Stricter regulations in the FDA approval process mean orthopaedic and spine device companies need to conduct extensive studies to prove a new device is equally or more effective than products already on the market

3.The trouble with requiring high level studies. Evidence-based medicine emphasizes level one studies, which have every bell and whistle to make sure they are done accurately with an emphasis on treatment for the patients. They are prospective, randomized, controlled, double-blinded studies and include objective testing analysis to make sure the study itself was done correctly.” Surgeons should be critical of studies funded by device companies because they could lead to a bias among the surgeons participating in the study if the surgeon has a financial investment.

4. Insurance companies and evidence-based medicine. Insurance companies are using published studies to form their coverage guidelines for orthopaedic and spine procedures. Many won’t cover an MRI or treatment unless there is a level one or level two study proving it’s necessary. Often, insurance companies will find studies supporting evidence that leads to a lower cost of care. Surgeons who practice evidence-based medicine stand to save millions of dollars in healthcare spending by performing proven surgeries and treatments on appropriately indicated patients. This is especially true in spine surgery, where more than $80 billion is spent annually treating back pain and all of the related modalities. Insurance companies’ approval guidelines run the risk of becoming too restricting and hindering the patient’s access to care, especially if the guidelines are created without physician input. Surgeons, as experts, really need to be the ones in charge of finding the evidence and making the guidelines.

5. Procedural guidelines’ impact on professional practice. Guidelines set forth by professional organizations examine literature surrounding a specific procedure, such as rotator cuff repair, and devise recommendations for treatment based on the strength of the previously conducted studies. “Sometimes, the guidelines from one society conflict with what another group has come up with,” he says. “Going forward, analysis of the evidence that is out there is going to be very helpful to justify the treatment of what we are doing.”

6. What the future holds. As the industry intensifies its demands for evidence-based medicine, orthopaedic and spine surgeons will most likely be driven to conduct research in areas that are lacking evidence. “We’re going to have to come up with a little better evidence and a little better rationale if we want to keep getting paid for what we do,” says Dr. Finn

However, some surgeons have patients who fall outside of the guidelines or evidence-based research and they may worry about malpractice suits because of the patient’s situation. This level of worry already happens in some fields, such as pulmonary embolism, where conflicting studies and guidelines exist. “As knowledge improves and we learn more about the field, these types of conflicts will likely go away,” he says.

The assessment of a successful treatment could also change, as the evidence-based research is more focused on the patient’s perception of their outcome. Instead of examining MRIs or the surgeon’s assessment, the research will focus on the patient’s quality of life and their ability to manage daily activities.


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