A global 27-item survey used Rasch modelling and differential item functioning to examine barriers to endoscopic spine surgery. Among 438 completers from 46 countries, training, institutional support and reimbursement varied substantially, with China and India appearing more adaptable than the United States, Latin America and Europe.
Key findings
- China and India reported stronger institutional and training support. The United States and Latin America emphasized reimbursement and training-integration barriers, while Europe showed low compensation and bureaucratic gatekeeping. Surgeon and patient interest was reported as high across regions.
Why this matters globally
Access to surgical innovation depends not only on clinical capability but also on incentives, training, reimbursement codes and institutional endorsement. The study identifies policy bottlenecks for health systems and professional societies.
Thai researcher contribution
Vit Kotheeranurak of Chulalongkorn University and King Chulalongkorn Memorial Hospital contributed Thai health-system experience to a 20-country expert network examining global surgical adoption.
Limitations to consider
This is an observational self-report survey subject to selection and nonresponse bias, with fewer than half of starters completing it. It contains no direct patient outcomes, and the case total is extrapolated. Rasch/DIF improves measurement quality but does not substitute for randomization.
Verify the original sources
The International Journal of Spine SurgeryRead the original article↗DOI: 10.14444/8908