Predicting clinical outcome and length of sick leave after surgery for lumbar spinal stenosis in Sweden: a multi-register evaluation
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.
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.
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.
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.
KeywordsLumbar spinal stenosis Regression analysis Patient-reported outcome Sick leave Prediction algorithms Spine surgery Global assessment Functional disability Socioeconomic factors Multi-register study
The authors thank Swespine, Swedish Society of Spinal Surgery (4 s) and all participating county councils. Partial funding from Forte programme Grant 2012/1688 (“Value and choice”) is gratefully acknowledged.
Funding for this research was provided by Sveus, through the Ministry of Health and Social Affairs (Dnr S2012/8356/FS) and seven Swedish regions. Sveus is a research collaboration in which seven Swedish regions develop systems for value-based monitoring of health care. The overarching aim of Sveus is to stimulate a value-driven, efficient and patient-centered health care, and the work has been carried out for a number of different patient groups, of which spine surgery is one.
Compliance with ethical standards
Conflict of interest
HI, CW and FB are employees at Ivbar Institute (a healthcare research consultancy), which has received research grants from Sveus (county council consortium) for the submitted work. FB holds shares in Ivbar Institute. The other authors declare that they have no conflict of interest.
- 11.Fritzell P, Hagg O, Wessberg P, Nordwall A, Swedish Lumbar Spine Study G (2001) Volvo Award Winner in Clinical Studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976) 26(23):2521–2532 (discussion 32-4) CrossRefGoogle Scholar
- 16.Hermansen E, Romild UK, Austevoll IM, Solberg T, Storheim K, Brox JI et al (2017) Does surgical technique influence clinical outcome after lumbar spinal stenosis decompression? A comparative effectiveness study from the Norwegian Registry for Spine Surgery. Eur Spine J 26(2):420–427CrossRefPubMedGoogle Scholar
- 17.Mobbs RJ, Li J, Sivabalan P, Raley D, Rao PJ (2014) Outcomes after decompressive laminectomy for lumbar spinal stenosis: comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy: clinical article. J Neurosurg Spine. 21(2):179–186CrossRefPubMedGoogle Scholar
- 23.Ghogawala Z, Benzel EC, Amin-Hanjani S, Barker FG 2nd, Harrington JF, Magge SN et al (2004) Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylolisthesis. J Neurosurg Spine 1(3):267–272CrossRefPubMedGoogle Scholar