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.
Graphical abstract
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Notes
Question: How is your leg/back pain today compared to before surgery? Possible answers: 0 = no pain before surgery (not included in statistical model), 1 = pain free, 2 = much improved, 3 = somewhat improved, 4 = unchanged, 5 = worse.
High score = high disability.
The first 14 days of sick-leave is not reported to the Swedish Social Insurance Agency, hence not accounted for in these analyses.
Retirement age in Sweden.
Elixhauser index, method for measuring patient comorbidity based on diagnosis codes in administrative data (includes mental disorders, drug and alcohol abuse, obesity, coagulopathy, weight loss and fluid and electrolyte disorders).
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Acknowledgements
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
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.
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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.
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Iderberg, H., Willers, C., Borgström, F. et al. Predicting clinical outcome and length of sick leave after surgery for lumbar spinal stenosis in Sweden: a multi-register evaluation. Eur Spine J 28, 1423–1432 (2019). https://doi.org/10.1007/s00586-018-5842-3
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DOI: https://doi.org/10.1007/s00586-018-5842-3