Abstract
Background and Purpose : Operative indications in orthopedic practice often differ from surgeon to surgeon. This incongruity and ambiguity of treatment proposals has been left poorly solved up to the present time. An ‘Operative Indication Score’ was invented for the purpose of helping to clarify the decision-making process and explanation of surgical indication, and was applied to patients undergo-ing or considering elective spinal surgery.
Methods : The sum of values given to 8 attributes including severity, tendency, effectiveness, risk, urgency, mental status, ability of the surgical team and negative relationships was designed to indicate relative degree of necessity for operative treatment. Three hundred patients undergoing elective spinal surgery and 124 new outpatients consulting for operative treatment were analyzed.
Results : The total score distribution demonstrated that there was a diversity of strength of operative indications. Patients undergoing a cervical operation tended to have higher total scores (stronger indications) in comparison to those undergoing a lumbar operation. The mental subset had significant relationships with the short-term clinical outcome.
Conclusion : The proposed scoring system is a unique psychological support tool designed to help not only surgeons to make and propose clinical decisions in a transparent manner, but also patients and colleagues to share the decision making. Although multi-centric, statistical analyses will be needed for wider clinical use, the authors' early experience suggested promising practical usefulness.
