title: Evaluation of current surgeon practice for patients undergoing lumbar spinal fusion surgery in the United Kingdom.
abstract: OBJECTIVE
  To ascertain current surgeon practice in the United Kingdom National Health Service for the management of patients undergoing lumbar spinal fusion surgery.
  
  
  METHODS
  Descriptive survey methodology utilised an online questionnaire administered through SurveyMonkey. Eligible participants were all surgeons currently carrying out lumbar spinal fusion surgery in the National Health Service. Two previous surveys and a recent systematic review informed questions. Statistical analyses included responder characteristics and pre-planned descriptive analyses. Open question data were interpreted using thematic analysis.
  
  
  RESULTS
  The response rate was 73.8%. Most surgeons (84%) were orthopaedic surgeons. Range of surgeon experience (1-15 years), number of operations performed in the previous 12 mo (4-250), and range of information used to predict outcome was broad. There was some consistency of practice: most patients were seen preoperatively; all surgeons ensured patients are mobile within 3 d of surgery; and there was agreement for the value of post-operative physiotherapy. However, there was considerable variability of practice: variability of protocols, duration of hospital stay, use of discharge criteria, frequency and timing of outpatient follow up, use of written patient information and outcome measures. Much variability was explained through patient-centred care, for example, 62% surgeons tailored functional advice to individual patients.
  
  
  CONCLUSIONS
  Current United Kingdom surgeon practice for lumbar spinal fusion is described. The surgical procedure and patient population is diverse, and it is therefore understandable that management varies. It is evident that care should be patient-centred. However with high costs and documented patient dissatisfaction it is important that further research evaluates optimal management.
authors.affiliation: Alison Rushton, Nicola Heneghan, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom.
authors.forename: Alison
authors.initials: A
authors.lastname: Rushton
authors.affiliation: Alison Rushton, Nicola Heneghan, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom.
authors.forename: Louise
authors.initials: L
authors.lastname: White
authors.affiliation: Alison Rushton, Nicola Heneghan, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom.
authors.forename: Alison
authors.initials: A
authors.lastname: Heap
authors.affiliation: Alison Rushton, Nicola Heneghan, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom.
authors.forename: Nicola
authors.initials: N
authors.lastname: Heneghan
keywords: Fusion; Lumbar spinal fusion; Management; Spinal surgery; Surgeon practice