A new study published in Spine examines how conflict of interest among spine surgeons and neurosurgeons affects practice patterns and complication rates.
Congress and the Institute of Medicine have taken action against conflict of interest, requiring device companies to disclose payments and gifts made to surgeons. Orthopedic surgeons and neurosurgeons receive among the highest industry payments of any specialists, and this study aimed to identify whether those payments affected practice patterns and complication rates.
The study authors examined Medicare-based data for spine surgeries performed in 2011 and 2012 as well as complication rate data from ProPublica-Surgeon-Scorecard for surgeries performed between 2009 and 2013. The researchers included payment data from the Open Payments website recorded from 2013 to 2014.
The study examined 2,110 surgeons and found:
1. Fusion rate was 8.8 percent with the complication rate for lumbar fusion at 4.1 percent and cervical fusion at 1.9 percent.
2. There was a "statistically significant but negligible relationship" between operative fusion and complication rates and the surgeons with disclosed payments or transactions from device companies.
3. The report showed variability in fusion rate, which suggests a lack of consensus in the spine community about the indications for spinal fusion.
4. Study authors concluded, "Our findings do not support a strong correlation between the payments a surgeon receives from the industry and their decisions to perform spine fusion or associated complication rates."
5. Open Payments data shows device companies and manufacturers paid $8.18 billion to healthcare providers in 2016, paying $1.02 billion for ownership or investment in the company and $2.8 billion in general payments. Around 1,500 of the payments were made to orthopedic spine surgeons.