Hanna Iderberg1,2, Carl Willers3,4, Fredrik Borgström3,5, Rune Hedlund6, Olle Hägg7, Hans Möller8, Ewald Ornstein9, Bengt Sandén10, Holger Stalberg11, Hans Torevall-Larsson12, Tycho Tullberg13, Peter Fritzell14,15. 1. Ivbar Institute, Hantverkargatan 8, 112 21, Stockholm, Sweden. hanna.iderberg@ivbar.com. 2. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden. hanna.iderberg@ivbar.com. 3. Ivbar Institute, Hantverkargatan 8, 112 21, Stockholm, Sweden. 4. Department for Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden. 5. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden. 6. Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden. 7. Spine Center Göteborg, Gothenburg, Sweden. 8. Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden. 9. Department of Orthopaedics, Örebro University Hosiptal, Örebro, Sweden. 10. Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. 11. Hälso- o. sjukvårdsförvaltningen, Stockholm County Council, Stockholm, Sweden. 12. Falu Lasarett, Falun, Sweden. 13. Stockholm Spine Center AB, Löwenströmska Sjukhuset, Upplands Väsby, Sweden. 14. Futurum Academy, Jönköping, Sweden. 15. S:t Göran Hospital, Stockholm, Sweden.
Abstract
PURPOSE: Lumbar spinal stenosis (LSS) can be surgically treated, with variable outcome. Studies have linked socioeconomic factors to outcome, but no nation-wide studies have been performed. This register-based study, including all patients surgically treated for LSS during 2008-2012 in Sweden, aimed to determine predictive factors for the outcome of surgery. METHODS: Clinical and socioeconomic factors with impact on outcome in LSS surgery were identified in several high-coverage registers, e.g., the national quality registry for spine surgery (Swespine, FU-rate 70-90%). Multivariate regression analyses were conducted to assess their effect on outcome. Two patient-reported outcome measures, Global Assessment of leg pain (GA) and the Oswestry Disability Index (ODI), as well as length of sick leave after surgery were analyzed. RESULTS: Clinical and socioeconomic factors significantly affected health outcome (both GA and ODI). Some predictors of a good outcome (ODI) were: being born in the EU, reporting no back pain at baseline, a high disposable income and a high educational level. Some factors predicting a worse outcome were previous surgery, having had back pain more than 2 years, having comorbidities, being a smoker, being on social welfare and being unemployed. CONCLUSIONS: The study highlights the relevance of adding socioeconomic factors to clinical factors for analysis of patient-reported outcomes, although the causal pathway of most predictors' impact is unknown. These findings should be further investigated in the perspective of treatment selection for individual LSS patients. The study also presents a foundation of case mix algorithms for predicting outcome of surgery for LSS. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: Lumbar spinal stenosis (LSS) can be surgically treated, with variable outcome. Studies have linked socioeconomic factors to outcome, but no nation-wide studies have been performed. This register-based study, including all patients surgically treated for LSS during 2008-2012 in Sweden, aimed to determine predictive factors for the outcome of surgery. METHODS: Clinical and socioeconomic factors with impact on outcome in LSS surgery were identified in several high-coverage registers, e.g., the national quality registry for spine surgery (Swespine, FU-rate 70-90%). Multivariate regression analyses were conducted to assess their effect on outcome. Two patient-reported outcome measures, Global Assessment of leg pain (GA) and the Oswestry Disability Index (ODI), as well as length of sick leave after surgery were analyzed. RESULTS: Clinical and socioeconomic factors significantly affected health outcome (both GA and ODI). Some predictors of a good outcome (ODI) were: being born in the EU, reporting no back pain at baseline, a high disposable income and a high educational level. Some factors predicting a worse outcome were previous surgery, having had back pain more than 2 years, having comorbidities, being a smoker, being on social welfare and being unemployed. CONCLUSIONS: The study highlights the relevance of adding socioeconomic factors to clinical factors for analysis of patient-reported outcomes, although the causal pathway of most predictors' impact is unknown. These findings should be further investigated in the perspective of treatment selection for individual LSS patients. The study also presents a foundation of case mix algorithms for predicting outcome of surgery for LSS. These slides can be retrieved under Electronic Supplementary Material.
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