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Effectiveness of surgery for sciatica with disc herniation is not substantially affected by differences in surgical incidences among three countries: results from the Danish, Swedish and Norwegian spine registries
Karolinska Univ Hosp, Dept Orthopaed, Stockholm, Sweden;Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Orthoped & Biotechnol, CLINTEC, K54, S-14186 Stockholm, Sweden.ORCID iD: 0000-0002-3382-8838
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Capio St Goran Hosp, Dept Orthopaed, Stockholm, Sweden; Jonkoping Cty Council, Acad Hlth & Care, Futurum, Jonkoping, Sweden;Swedish Natl Spine Register, Swespine Steering Grp, Jonkoping, Sweden.
Swedish Natl Spine Register, Swespine Steering Grp, Jonkoping, Sweden;Spine Ctr Goteborg, Gothenburg, Sweden.
Qulturum Ctr Learning & Innovat Healthcare, Jonkoping, Sweden.
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2019 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 28, no 11, p. 2562-2571Article in journal (Refereed) Published
Abstract [en]

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. [GRAPHICS] .

Place, publisher, year, edition, pages
SPRINGER , 2019. Vol. 28, no 11, p. 2562-2571
Keywords [en]
Lumbar disc herniation, Surgery, Outcome
National Category
Surgery Orthopaedics
Identifiers
URN: urn:nbn:se:uu:diva-397041DOI: 10.1007/s00586-018-5768-9ISI: 000492423700015PubMedID: 30269234OAI: oai:DiVA.org:uu-397041DiVA, id: diva2:1371242
Available from: 2019-11-19 Created: 2019-11-19 Last updated: 2019-11-19Bibliographically approved

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