Predictors of willingness to undergo back surgery: a survey of Australian privately insured adults with chronic back pain.

OBJECTIVE

Spinal surgery rates in Australia continue to rise despite limited evidence for their effectiveness in managing uncomplicated chronic back pain. This study examined patient-level factors that influence willingness to undergo surgery, to informing future work promoting non-surgical care pathways.

METHODS

We conducted a cross-sectional online survey in March 2025 of 152 privately insured Australian adults with chronic low back pain. Participants reported pain characteristics, functional interference, prior imaging and pain-related beliefs (expectations of recovery, self-efficacy and catastrophising). Willingness to undergo spinal surgery within 5 years was assessed on a 5-point scale, and dichotomised into 'willing' (3-4) and 'unwilling' (0-1); respondents answering 'unsure' were excluded. Logistic regression examined predictors of willingness to consider surgery.

RESULTS

Of 152 participants (mean age 59.3 years, 64% female), 24% expressed willingness to undergo surgery. Negative pain beliefs, higher pain intensity and younger age significantly predicted willingness, with the strongest effect seen for negative pain beliefs (OR 2.62, 95% CI 1.16-5.92, P = 0.02). Functional interference, imaging history and gender showed positive, but non-significant, associations.

CONCLUSION

Negative pain beliefs predict willingness to undergo spinal surgery. This finding has important policy implications, suggesting that addressing belief-driven demand may help reduce the economic burden of surgery by directing patients towards guideline-based, high-value, non-surgical care.