Determinants of Surgeon and Center Selection in Recurrent Lumbar Disc Herniation: A Survey-Based Analysis of Patient Decision-Making Nüks Lomber Disk Hernisinde Merkez ve Cerrah Değişimi: Hasta Tercihlerini Belirleyen Etkenler Üzerine Anket Temelli Bir Araştırma
Medical Journal of Bakirkoy, cilt.21, sa.4, ss.374-379, 2025 (ESCI, Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 21 Sayı: 4
- Basım Tarihi: 2025
- Doi Numarası: 10.4274/bmj.galenos.2025.2025.7-15
- Dergi Adı: Medical Journal of Bakirkoy
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, CINAHL, EMBASE, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.374-379
- Anahtar Kelimeler: Choice behavior, continuity of patient care, disc herniation, health services accessibility, patient satisfaction, recurrence, reoperation, second opinion, T & uuml;rkiye
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objective: To investigate factors influencing patients’ selection of surgeon and treatment center for revision surgery for recurrent lumbar disc herniation in Türkiye. Understanding the motivations behind changing providers after primary spinal surgery is crucial for enhancing continuity of care and informing health policy within mixed healthcare systems. Methods: This cross-sectional observational study was conducted at a tertiary neurosurgery center in İstanbul. Forty patients who had previously undergone lumbar discectomy and subsequently required revision surgery were interviewed via structured telephone questionnaires. Patients were asked about their reasons for changing surgeons or institutions, their satisfaction with their initial surgery, and whether they had contacted their index surgeon following recurrence. Descriptive statistics were used to analyze response frequencies. Additionally, two-proportion z-tests were used to compare key findings against data from the landmark international literature. Results: The most common reasons for changing providers were seeking a second opinion (45%), dissatisfaction with prior care (30%), and financial barriers (35%). All 14 patients who had initially undergone surgery in private hospitals opted for revision in public institutions, citing cost concerns. Despite 70% of patients reporting satisfaction with their index surgery, only 35% reconsulted their original surgeon after recurrence of symptoms. A minority (10%) deliberately avoided their initial provider despite having access. Furthermore, the proportion of patients who did not reconsult their index surgeon (65%) was significantly higher than that reported in benchmark United States of America studies (p=0.017). Conclusion: Although patient satisfaction with initial surgery was generally high, provider change was frequently driven by economic pressures and informational needs, rather than geographic relocation or outright dissatisfaction. These findings underscore the importance of transparent preoperative counseling and cost awareness, particularly in mixed public-private systems like Türkiye’s. Future research should evaluate the impact of provider continuity on revision outcomes and explore strategies to support equitable access to complex spinal care.