Optimizing outcomes and experience for patients traveling abroad for spine surgery: A survey of neurosurgeons and orthopedic spine surgeons in Saudi Arabia

Background: It is widely accepted that patients with complex medical diagnoses and those with the means will travel for specialized medical care abroad. For various reasons, patients from the Gulf countries, including the Kingdom of Saudi Arabia (KSA), have comprised a significant proportion of patients traveling abroad for care. Rarely, however, have local physicians and surgeons been involved at the granular level in these decisions. This study aims to better understand the opinions, insights, and suggestions of local spine surgeons in KSA on the outbound surgical services provided to their patients. 
Materials and Methods: A cross-sectional study was conducted from April 11 to April 27, 2022. An electronic Qualtrics online survey with 12 items was sent to all spine surgeons from KSA, identified by the local neurosurgery, orthopedics, and spine societies. 
Results: A total of 110 participants were identified with 86 responses. The patient’s perception of the local system, the complexity of the case, and the opportunity for tourism, in that order, were selected as the main reasons for patients traveling abroad. The top three destinations for spine surgery were Germany (31%), the USA (23%), and Egypt (16%). Hospital and surgeon’s reputations were chosen as the most likely factors for patients to select their destination. The quality of care received abroad was considered fair (49%) or good (31%), while the communication between stakeholders and the patient was considered poor by 72% and 52% of the respondents, respectively. 
Conclusion: This study highlights the need to engage local physicians in the conversation involving destination services. While most Saudi surgeons surveyed consider the care abroad acceptable for their patients, the vast majority have identified a gap in communication among treating physicians, local physicians, and patients. Many have also suggested a need for better education and awareness locally to improve the perception of the local capabilities.