Variation in surgical management of neurogenic bowel among centers participating in National Spina Bifida Patient Registry.
Jonathan C Routh, David B Joseph, Tiebin Liu and 5 others
PMID 29125521WHAT IT FOUND
Bowel surgery for patients with spina bifida varied widely by clinic, from 3% to 38%, even after accounting for clinical and demographic factors.
The study reports patterns, not whether surgery helps.
Key findings
01Of 5,528 patients with spina bifida, 1,088 (19.7%) underwent 1,305 neurogenic bowel procedures.
02Neurogenic bowel procedure use varied widely by clinic, from 3% at some clinics to 38% at others.
03After adjustment, clinic, higher lesion level, older age, MMC, non-Hispanic white race/ethnicity, reduced mobility, private insurance, and female gender were associated with neurogenic bowel procedures.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study reports which surgeries were done, not whether they improved continence, bowel function, independence, or quality of life. It is an association study from registry records, so it cannot show that any factor caused surgery or that one surgical choice was better. Patients were recruited from 19 specialized spina bifida clinics, so the sample may not represent people with spina bifida who do not attend such clinics. Data were collected at different clinics, and outcome definitions may be interpreted differently across sites. Enrollment was not random, and eligible patients who were not enrolled may differ from those enrolled, although the selection-bias check found little evidence of a major effect. Important unmeasured factors, such as family preference, surgeon philosophy, resources, and reimbursement, may influence surgical decisions.
Declared interests
The authors report no conflict of interest. The article is listed as supported by NIH and U.S. government sources, but the text does not say these funders designed the study or wrote the manuscript.
The easy way to misread this
Do not read the 3% to 38% clinic variation as proof that surgery is overused or underused at particular centers. The study reports who had procedures, not whether the procedures improved continence or quality of life.