Tobias Lagerbäck1,2, Peter Fritzell3,4,5,6, Olle Hägg6,7, Dennis Nordvall8, Greger Lønne9,10,11, Tore K Solberg11,12,13, Mikkel Ø Andersen14,15, Søren Eiskjær16, Martin Gehrchen17, Wilco C Jacobs18, Miranda L van Hooff19,20, Paul Gerdhem21,22,6. 1. Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden. tobias.lagerback@ki.se. 2. Division of Orthopedics and Biotechnology, CLINTEC, K54, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 86, Stockholm, Sweden. tobias.lagerback@ki.se. 3. Department of Orthopaedics, Capio St Göran Hospital, Stockholm, Sweden. 4. Division of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. 5. Futurum, Academy for Health and Care, Jönköping County Council, Jönköping, Sweden. 6. Swespine Steering Group, Swedish National Spine Register, Jönköping, Sweden. 7. Spine Center Göteborg, Göteborg, Sweden. 8. Qulturum Center for Learning and Innovation in Healthcare, Jönköping, Sweden. 9. Department of Orthopaedics, Innlandet Hospital Trust, Lillehammer, Norway. 10. National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. 11. The Norwegian Registry for Spine Surgery (NORspine), Northern Norway Regional Health Authority, Bodø, Norway. 12. Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway. 13. Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway. 14. Sector for Spine Surgery and Research, Lillebælt Hospital, Middelfart, Denmark. 15. DaneSpine Steering Group, Danish National Spine Register, Middelfart, Denmark. 16. Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark. 17. Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet University of Copenhagen, Copenhagen, Denmark. 18. The Health Scientist, The Hague, The Netherlands. 19. Department of Research, Sint Maartenskliniek, Ubbergen, The Netherlands. 20. Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. 21. Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden. 22. Division of Orthopedics and Biotechnology, CLINTEC, K54, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 141 86, Stockholm, Sweden.
Abstract
PURPOSE: Yearly incidence of surgery for symptomatic lumbar disc herniation varies and is 29/100,000 in Sweden, 46/100,000 in Denmark and 58/100,000 in Norway. This variation was used to study whether differences in surgical incidence were associated with differences in preoperative patient characteristics as well as patient-reported outcomes. METHODS: Data from the national spine registers in Sweden, Denmark and Norway during 2011-2013 were pooled, and 9965 individuals, aged 18-65 years, of which 6468 had one-year follow-up data, were included in the study. Both absolute and case-mix-adjusted comparisons of the primary outcome Oswestry Disability Index (ODI) and the secondary outcomes EQ-5D-3L, and Numerical Rating Scale (NRS) for leg and back pain were performed. Case-mix adjustment was done for baseline age, sex, BMI, smoking, co-morbidity, duration of leg pain and preoperative value of the dependent variable. RESULTS: Mean improvement in the outcome variables exceeded previously described minimal clinical important change in all countries. Mean (95% CI) final scores of ODI were 18 (17-18), 19 (18-20) and 15 (15-16) in Sweden, Denmark and Norway, respectively. Corresponding results of EQ-5D-3L were 0.74 (0.73-0.75), 0.73 (0.72-0.75) and 0.75 (0.74-0.76). Results of NRS leg and back pain behaved similarly. Case-mix adjustment did not alter the findings substantially. CONCLUSION: We found no clear association between incidence of surgery for lumbar disc herniation and preoperative patient characteristics as well as outcome, and the differences between the countries were lower than the minimal clinical important difference in all outcomes. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: Yearly incidence of surgery for symptomatic lumbar disc herniation varies and is 29/100,000 in Sweden, 46/100,000 in Denmark and 58/100,000 in Norway. This variation was used to study whether differences in surgical incidence were associated with differences in preoperative patient characteristics as well as patient-reported outcomes. METHODS: Data from the national spine registers in Sweden, Denmark and Norway during 2011-2013 were pooled, and 9965 individuals, aged 18-65 years, of which 6468 had one-year follow-up data, were included in the study. Both absolute and case-mix-adjusted comparisons of the primary outcome Oswestry Disability Index (ODI) and the secondary outcomes EQ-5D-3L, and Numerical Rating Scale (NRS) for leg and back pain were performed. Case-mix adjustment was done for baseline age, sex, BMI, smoking, co-morbidity, duration of leg pain and preoperative value of the dependent variable. RESULTS: Mean improvement in the outcome variables exceeded previously described minimal clinical important change in all countries. Mean (95% CI) final scores of ODI were 18 (17-18), 19 (18-20) and 15 (15-16) in Sweden, Denmark and Norway, respectively. Corresponding results of EQ-5D-3L were 0.74 (0.73-0.75), 0.73 (0.72-0.75) and 0.75 (0.74-0.76). Results of NRS leg and back pain behaved similarly. Case-mix adjustment did not alter the findings substantially. CONCLUSION: We found no clear association between incidence of surgery for lumbar disc herniation and preoperative patient characteristics as well as outcome, and the differences between the countries were lower than the minimal clinical important difference in all outcomes. These slides can be retrieved under Electronic Supplementary Material.
Entities:
Keywords:
Lumbar disc herniation; Outcome; Surgery
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