SURGEON DECISION-MAKING IN THE USE OF TISSUE-ENGINEERING STRATEGIES

Management of bone defects is not only burdensome for the patient, but also socioeconomically highly relevant. Thus, to achieve effective and cost-efficient bone defect treatment, it is important to understand the decision-making processes of surgeons and scientists in relation to current options and future possibilities for biomaterial and implant development. Against this background, the results of a prospective cross-sectional survey study (performed online between October 2022 and March 2023) looking at surgeons' and scientists' opinions on the treatment of bone defects have been published previously, showing a significant translational gap between both groups. Here we present the results of a subgroup analysis among 265 surgeons (235 male, 39 female, 1 divers) that participated in the survey. From the original survey questions, five questions were identified as independent variables and ten questions were identified as dependent variables for further statistical analysis in Matlab (Version R2023b. Natick, Massachusetts: The MathWorks Inc.). The multiple regression analysis across the selected survey questions revealed varying degrees of influence from independent variables such as participant age, experience, and monthly surgeries on perceptions of bone defect treatments and related innovations. Regarding decision-making input, none of the independent variables showed significant effects ( p > 0.1) despite a moderate F-statistic (1.64, p = 0.136). A significant influence of professional meetings ( p = 0.009) on views regarding synthetic bone substitutes replacing autologous grafts was observed. Across all models, root mean squared errors (RMSE) ranged from 16.7 to 30, reflecting notable variance in participant responses not explained by the predictors, emphasizing a need for further exploration of external influencing factors. The analysis of correlations between participant characteristics and their preferences for transitioning to a new bone regeneration technology revealed that participants with more bone defect experience are more likely to value witnessing a procedure firsthand (Spearman's rho = 0.174, p = 0.011; Kendall's Tau = 0.130, p = 0.01) and that those with more bone defect experience are somewhat more likely to value peer endorsement (Spearman's rho = −0.153, p = 0.027; Kendall's Tau = −0.116, p = 0.026). To conclude, our results substantiate the recommendation to treat complex bone defects at selected centres of excellence with large numbers of cases. The realization of fellowships at these centres could support the acceptance and implementation of new treatment options. Finally, the organization of interdisciplinary and collaborative meetings on a broad basis to discuss holistic treatment approaches is deemed beneficial.