AN INTERNATIONAL COMPARISON OF BACK SURGERY RATES

Summary of Background Data. Although high geographic variation in back surgery rates within the United States have been documented, internat ional comparisons have not been published. Methods. The authors compar ed rates of back surgery in eleven developed countries to determine if back surgery rates are higher: 1) in the United States than in other developed countries, 2) in countries with more neurologic and orthopae dic surgeons per capita, and 3) in countries with higher rates of othe r surgical procedures. Data on back surgery rates and physician supply were obtained from health agencies within these eleven countries. Cou ntry-specific rates of other surgical procedures were available from p ublished sources. Results. The rate of back surgery in the United Stat es was at least 40% higher than in any other country and was more than five times those in England and Scotland. Back surgery rates increase d almost linearly with the per capita supply of orthopaedic and neuros urgeons in the country. Countries with high back surgery rates also ha d high rates of other discretionary procedures such as tonsillectomy a nd hysterectomy. Conclusions. These findings illustrate the potentiall y large impact of health system differences on rates of back surgery. Better outcome studies, however, are needed to determine whether Ameri cans are being subjected to excessive surgery or if those in other dev eloped countries are suffering because back surgery is underutilized.