133. Patient-reported outcomes following surgery for lumbar disc herniation: comparison of a universal and multitier health care system

Abstract INTRODUCTION Canada has a universal health care system that is government funded and access to specialist care requires a referral by general practitioners. The United States utilizes a blended public and private payer system where insured patients can directly access specialists. The purpose of this study is to investigate whether there are differences in outcomes in the two systems. METHODS Surgical lumbar disc herniation patients treated between 2013 and 2016 in Canada that were enrolled in the Canadian Spine Outcome Research Network (CSORN) prospective multicenter registry. The Canadian cohort was compared with the surgical cohort enrolled in the Spine Patients Outcome Research Trial (SPORT) study. Baseline demographics and spine-related patient reported outcomes (PROs) were compared at 3 mo and 1 yr postoperatively. RESULTS The CSORN cohort consisted of 703 patients and the SPORT cohort was made up of 573 patients. The rate of females in each cohort was similar (47.2% vs 46.4%, P = .78), however, patients in the CSORN cohort were older (46.2 13.2 vs 41.6 10.9, P < .001), had a higher rate of smoking (32.0% vs 22.8%, P < .001), and were more likely to be employed (66.9% vs 61.3%, P = .034). The CSORN cohort had a slightly lower Owestry Disability score at baseline (50.515.1 vs 55.7 19.6, P < .01) but had a higher proportion of patients with a symptom duration greater than 6 mo (44.5% vs 21.1%, P < .0001). The CSORN cohort demonstrated significantly greater rates of satisfaction after surgery at 3 mo (74.8% vs 65.3%, P = .003) and 1 yr (81.4% vs 68.7%, P < .001). Improvements in back and leg pain followed similar trajectories. CONCLUSION Patients undergoing surgical treatment for lumbar disc herniation in Canada (CSORN cohort) reported higher rates of satisfaction at 3 mo and 1 yr postoperatively compared to the United States cohort (SPORT) despite having longer durations of symptoms prior to surgery.

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Patient-Reported Outcomes Following Surgery for Lumbar Disc Herniation: Comparison of a Universal and Multitier Health Care System

Global Spine Journal ◽

10.1177/21925682211046961 ◽

2021 ◽

pp. 219256822110469

Author(s):

Oliver GS Ayling ◽

Tamir Ailon ◽

Michael Craig ◽

Nicolas Dea ◽

Greg McIntosh ◽

...

Keyword(s):

Health Care ◽

Health Care System ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Universal Health Care ◽

Universal Health Care System ◽

Patient Reported ◽

Universal Health ◽

Care System

Study Design Ambispective cohort study. Objective Canada has a government-funded universal health care system. The United States utilizes a multitier public and private system. The objective is to investigate differences in clinical outcomes between those surgically treated for lumbar disc herniation in a universal health care and multitier health system. Methods Surgical lumbar disc herniation patients enrolled in the Canadian Spine Outcome Research Network (CSORN) were compared with the surgical cohort enrolled in the Spine Patients Outcome Research Trial (SPORT) study. Baseline demographics and spine-related patient-reported outcomes (PROs) were compared at 3 months and 1 year post-operatively. Results The CSORN cohort consisted of 443 patients; the SPORT cohort had 763 patients. Patients in the CSORN cohort were older (46.4 ± 13.5 vs 41.0 ± 10.8, P < .001) and were more likely to be employed (69.5% vs 60.3%, P = .003). The CSORN cohort demonstrated significantly greater rates of satisfaction after surgery at 3 months (87.2% vs 64.8%, P < .0001) and 1 year (85.6% vs 69.6%, P < .0001). Improvements in back and leg pain followed similar trajectories in the two cohorts, but there was less improvement on ODI in the CSORN cohort ( P < .01). On multivariable logistic regression, the CSORN cohort was a significant independent predictor of patient satisfaction at 1-year follow-up ( P < .001). Conclusions Despite less improvement on ODI, patients enrolled in CSORN, as part of a universal health care system, reported higher rates of satisfaction at 3 months and 1 year post-operatively compared to patients enrolled within a multitier health system.

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Patient-reported Outcomes After Surgery for Lumbar Disc Herniation, a Randomized Controlled Trial Comparing the Effects of Referral to Municipal Physical Rehabilitation Versus No Referral

Spine ◽

10.1097/brs.0000000000003221 ◽

2020 ◽

Vol 45 (1) ◽

pp. 3-9 ◽

Cited By ~ 2

Author(s):

Rune T. Paulsen ◽

Leah Y. Carreon ◽

Mikkel Ø. Andersen

Keyword(s):

Randomized Controlled Trial ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Patient Reported Outcomes ◽

Controlled Trial ◽

Lumbar Disc ◽

Physical Rehabilitation ◽

Randomized Controlled ◽

Patient Reported

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Validation of Patient-Reported Outcomes Measurement Information System (PROMIS) in Surgically Managed Lumbar Disc Herniation Patients

The Spine Journal ◽

10.1016/j.spinee.2015.07.379 ◽

2015 ◽

Vol 15 (10) ◽

pp. S250 ◽

Cited By ~ 1

Author(s):

Alpesh A. Patel ◽

Surabhi Bhatt ◽

Shah-Nawaz M. Dodwad ◽

Jason W. Savage ◽

Wellington K. Hsu ◽

...

Keyword(s):

Information System ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Patient Reported Outcomes ◽

Lumbar Disc ◽

Measurement Information ◽

Outcomes Measurement ◽

Patient Reported ◽

Measurement Information System

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CORR Insights®: Recurrent Versus Primary Lumbar Disc Herniation Surgery: Patient-reported Outcomes in the Swedish Spine Register Swespine

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-014-3669-8 ◽

2014 ◽

Vol 473 (6) ◽

pp. 1985-1987 ◽

Cited By ~ 1

Author(s):

Frank M. Phillips

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Patient Reported Outcomes ◽

Lumbar Disc ◽

Surgery Patient ◽

Patient Reported ◽

Spine Register

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Outcomes following discectomy for lumbar disc herniation in patients with substantial back pain

Journal of Neurosurgery Spine ◽

10.3171/2020.4.spine191382 ◽

2020 ◽

Vol 33 (5) ◽

pp. 623-626

Author(s):

Simon Thorbjørn Sørensen ◽

Rachid Bech-Azeddine ◽

Søren Fruensgaard ◽

Mikkel Østerheden Andersen ◽

Leah Carreon

Keyword(s):

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Patient Reported Outcomes ◽

Lumbar Disc ◽

Leg Pain ◽

Patient Reported ◽

Vas Scores ◽

The Mean

OBJECTIVEPatients with lumbar disc herniation (LDH) typically present with lower-extremity radiculopathy. However, there are patients who have concomitant substantial back pain (BP) and are considered candidates for fusion. The purpose of this study was to determine if patients with LDH and substantial BP improve with discectomy alone.METHODSThe DaneSpine database was used to identify 2399 patients with LDH and baseline BP visual analog scale (VAS) scores ≥ 50 who underwent a lumbar discectomy at one of 3 facilities between June 2010 and December 2017. Standard demographic and surgical variables and patient-reported outcomes, including BP and leg pain (LP) VAS scores (0–100), Oswestry Disability Index (ODI), and European Quality of Life–5 Dimensions Questionnaire (EQ-5D) at baseline and 12 months postoperatively, were collected.RESULTSA total of 1654 patients (69%) had 12-month data available, with a mean age of 48.7 years; 816 (49%) were male and the mean BMI was 27 kg/m2. At 12 months postoperatively, there were statistically significant improvements (p < 0.0001) in BP (72.6 to 36.9), LP (74.8 to 32.6), ODI (50.9 to 25.1), and EQ-5D (0.25 to 0.65) scores.CONCLUSIONSPatients with LDH and LP and concomitant substantial BP can be counseled to expect improvement in their BP 12 months after surgery after a discectomy alone, as well as improvement in their LP.

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