179 - Appropriate Use Criteria in Spine Surgery

Abstract

Appropriate use criteria (AUC) determine which patients certain surgical procedures are appropriate for or worth doing due to a sufficiently wide margin of benefit over risk. AUC are created through the RAND Corporation/University of California Los Angeles Appropriateness Method, which uses evidence-based review along with expert panel discussion to provide practitioners and patients with another tool for clinical and surgical decision-making. AUC can also be used to determine where procedures are being overused or underused, which can help improve the overall efficiency of our healthcare system. The field of spine surgery has several published AUC to help providers make evidence-based decisions regarding the appropriateness of surgical intervention, specifically for cervical fusion, lumbar laminectomy, degenerative lumbar scoliosis, degenerative lumbar spondylolisthesis, vertebral fragility fractures, and persistent pain following spinal surgery. Besides the use of AUC in the clinical setting to aid decision making, AUC can be used by payers and policymakers and may impact the future practice of all spine surgeons, as evidenced by the birth of the Medicare AUC program.