Analysis of Internet Information on Lateral Lumbar Interbody Fusion

Use of a custom website by orthopaedic sports medicine surgical patients: If you build it, will they come?

BACKGROUND

Internet use is nearly ubiquitous, and orthopaedic patients are increasingly utilizing the Internet for medical information. The quality of resources available to patients is variable, and patients may benefit from physician guidance. A recent study showed only 11% of orthopaedic trauma patients accessed a custom-designed website developed by a physician. The purpose of this study was to determine whether orthopaedic sports medicine patients would use a custom-designed website and what factors would be associated with website use.

METHODS

A prospective study was conducted of patients undergoing eight common orthopaedic sports medicine procedures from April 2017 to December 2017.108 patients were enrolled and provided access to the website that allowed tracking of each patient's website use. The sports medicine cohort was compared to a previously published trauma cohort using the same methodology in a similar population at the same institution. The custom-designed website was replicated from the previous trauma study, but with the patient information now focused on sports medicine conditions and procedures. Patients' access to the website, tracking of website use, data collection, and analysis was identical to the previous trauma cohort. Bivariate and multivariate analyses were performed to determine which patient factors were associated with website use.

RESULTS

33 orthopaedic sports medicine patients (31%) accessed the website, and of those, 96% found the website helpful or very helpful. Orthopaedic sports medicine patients were nearly 3 times more likely to use the designated website than orthopaedic trauma patients (31% vs. 11%; p = 0.0004). Higher education predicted website use (p = 0.006). Age, gender, race, employment status, and household income were not predictive of use (p = 0.49, 0.27, 0.23, 0.15, 0.58; respectively). Anterior cruciate ligament (ACL) reconstruction was associated with website use as compared to meniscus and cartilage surgery (42% vs. 20%; p = 0.037). Nominal logistic regression analysis confirmed higher level of education (p = 0.00001) and ACL reconstruction (p = 0.0005) independently predicted website use.

CONCLUSION

Orthopaedic sports medicine surgical patients are more likely to use a custom-designed informational website than orthopaedic trauma patients. However, only 31% of sports medicine patients accessed the website. Inherent differences between groups may account for the differences in website use. Higher level of education is predictive of website use, as is ACL reconstruction for knee surgery patients. Physicians should work to direct patients to high quality Internet resources given the vast amount of potentially unreliable information available.

Sources of Patients' Expectations of Lumbar Surgery

STUDY DESIGN

A cross-sectional, mixed methods analysis of sources of expectations of lumbar surgery.

OBJECTIVE

The aim of this study was to ascertain sources of expectations and compare them to clinical characteristics.

SUMMARY OF BACKGROUND DATA

Understanding where patients obtain expectations of lumbar surgery is necessary in order to develop interventions to foster appropriate expectations.

METHODS

This was a qualitative-quantitative study of 428 patients interviewed preoperatively with a 20-item validated survey, which asks patients how much improvement they expect per item. Patients then were asked open-ended questions about how they came to have these expectations and, using qualitative analysis, responses were grouped into themes representing different sources of expectations. The likelihood of citing various sources was then assessed with odds ratios (ORs) based on demographic and clinical characteristics.

RESULTS

Patients' mean age was 55 years, 80% had degenerative diagnoses and 24% had prior lumbar surgery. Patients volunteered multiple sources; most prevalent were current surgeon (83%), internet resources (55%), social network contacts (26%), other physicians (22%); and previous experience (65%) for the subgroup who had prior lumbar surgery. Patients were more likely to cite their surgeon if they had less disability [OR 2.8, confidence interval (CI) 1.3-5.8, P = 0.007], were treated with conservative care, such as physical therapy (OR 2.7, CI 1.6-4.7, P = 0.0003), and had symptoms for ≤12 months (OR 1.8, CI 1.1-3.0, P = 0.03). Patients who cited the internet were employed (OR 2.2; CI 1.5-3.3; P < 0.0001), were treated with physical therapy (OR 1.9; CI 1.2-3.1; P = 0.006), had a negative screen for depression (OR 1.8; CI 1.2-2.8; P = 0.004), and were younger (OR 1.6; CI 1.1-2.4; P = .02). Patients were less likely to expect complete improvement for most items of the survey if they had prior lumbar surgery (P = 0.002) or other orthopedic surgery (P = 0.02).

CONCLUSION

Patients derive their expectations of lumbar surgery from multiple sources. Some sources are modifiable through enhanced communication with surgeons and potentially through novel modes of education, such as web-based resources that are specifically designed to address expectations.

LEVEL OF EVIDENCE

2.

Online Ratings of Spine Surgeons: Analysis of 208 Surgeons

STUDY DESIGN

Observational study.

OBJECTIVE

To evaluate the online ratings of spine surgeons and variables that may affect online ratings.

SUMMARY OF BACKGROUND DATA

Physician review Web sites (PRW) are rapidly growing for-profit businesses. Most orthopedic surgeons are rated on at least one PRW as are other surgical specialists. To date the online ratings of spine surgeons have not been evaluated.

METHODS

Cervical Spine Research Society surgeon ratings on five physician rating Web sites were performed in April 2016: "healthgrade.com," "vitals.com," "ratemd.com," "webmd.com," and "yelp.com." Numeric ratings from the PRWs were standardized on a scale of 0 to 100 with a higher score indicating positive ratings. Sex, practice sector (academic or private), specialty (orthopedics or neurosurgery), geographic location, and years of practice were also collected.

RESULTS

A total of 209 spine surgeons were included in our study. Of the 209 spine surgeons, 208 (99.52%) were rated at least once in one of the five PRWs. Average number of ratings per surgeon was 2.96. Average rating was 80 (40-100). There were four female (1.92%) and 204 male surgeons (98.1%). There were 121 (58.2%) in academic practice and 87 (41.8%) in private practice. There were 175 (84.1%) orthopedic surgeons and 33 (15.9%) neurosurgeons. Most of the surgeons were Caucasian 163 (78.4%) and worked in the South and Northeast 135 (64.9%). Those in academic practice had significantly higher ratings (81.6 vs. 77.65; P = 0.026). Number of years in practice was significantly associated with ratings (P = 0.0003) with those in practice for 21 or more years having significantly lower ratings.

CONCLUSION

In this first study evaluating the online ratings of spine surgeons, we found that 99.5% of spine surgeon had at least one rating on a PRW. The average score, 80, indicated mostly positive ratings. Being in practice for 20 years or less and being in academic practice significantly associated with higher ratings.

LEVEL OF EVIDENCE

4.