Surgery for herniated lumbar disc in private vs public hospitals: A pragmatic comparative effectiveness study

Autor: Sasha Gulati, Tore Solberg, Sven M. Carlsen, Steinar Westin, Kristian Onarheim, Mattis Aleksander Madsbu, Øyvind Salvesen, Øystein P. Nygaard
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Adult
Male
medicine.medical_specialty
Original Article - Spine degenerative
Neurosurgery
Intervertebral Disc Degeneration
Neurosurgical Procedures
Intervertebral disc displacement
Hospitals
Private
03 medical and health sciences
Sciatica
0302 clinical medicine
Postoperative Complications
Quality of life
medicine
Back pain
VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Neurosurgery: 786
Humans
VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Nevrokirurgi: 786
030212 general & internal medicine
Public health
Lumbar Vertebrae
business.industry
Hospitals
Public
Norway
Length of Stay
Middle Aged
Oswestry Disability Index
Surgery
Orthopedics
Treatment Outcome
Propensity score matching
Cohort
Orthopedic surgery
Quality of Life
Female
Neurology (clinical)
medicine.symptom
Complication
business
030217 neurology & neurosurgery
Zdroj: Acta Neurochirurgica
ISSN: 0942-0940
0001-6268
Popis: Background There is limited evidence on the comparative performance of private and public healthcare. Our aim was to compare outcomes following surgery for lumbar disc herniation (LDH) in private versus public hospitals. Methods Data were obtained from the Norwegian registry for spine surgery. Primary outcome was change in Oswestry disability index (ODI) 1 year after surgery. Secondary endpoints were quality of life (EuroQol EQ-5D), back and leg pain, complications, and duration of surgery and hospital stays. Results Among 5221 patients, 1728 in the private group and 3493 in the public group, 3624 (69.4%) completed 1-year followup. In the private group, mean improvement in ODI was 28.8 points vs 32.3 points in the public group (mean difference − 3.5, 95% CI − 5.0 to − 1.9; P for equivalence < 0.001). Equivalence was confirmed in a propensity-matched cohort and following mixed linear model analyses. There were differences in mean change between the groups for EQ-5D (mean difference − 0.05, 95% CI − 0.08 to − 0.02; P = 0.002) and back pain (mean difference − 0.2, 95% CI − 0.2, − 0.4 to − 0.004; P = 0.046), but after propensity matching, the groups did not differ. No difference was found between the two groups for leg pain. Complication rates was lower in the private group (4.5% vs 7.2%; P < 0.001), but after propensity matching, there was no difference. Patients operated in private clinics had shorter duration of surgery (48.4 vs 61.8 min) and hospital stay (0.7 vs 2.2 days). Conclusion At 1 year, the effectiveness of surgery for LDH was equivalent in private and public hospitals. C The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Databáze: OpenAIRE
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