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Predicting clinical outcome and length of sick leave after surgery for lumbar spinal stenosis in Sweden: a multi-register evaluation
Ivbar Inst, Hantverkargatan 8, S-11221 Stockholm, Sweden;Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Stockholm, Sweden.
Ivbar Inst, Hantverkargatan 8, S-11221 Stockholm, Sweden;Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden.
Ivbar Inst, Hantverkargatan 8, S-11221 Stockholm, Sweden;Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Stockholm, Sweden.
Sahlgrens Univ Hosp, Dept Orthopaed, Gothenburg, Sweden.
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2019 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 28, no 6, p. 1423-1432Article in journal (Refereed) Published
Abstract [en]

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 2years, 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.

Place, publisher, year, edition, pages
2019. Vol. 28, no 6, p. 1423-1432
Keywords [en]
Lumbar spinal stenosis, Regression analysis, Patient-reported outcome, Sick leave, Prediction algorithms, Spine surgery, Global assessment, Functional disability, Socioeconomic factors, Multi-register study
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Orthopaedics
Identifiers
URN: urn:nbn:se:uu:diva-389615DOI: 10.1007/s00586-018-5842-3ISI: 000471266200019PubMedID: 30511244OAI: oai:DiVA.org:uu-389615DiVA, id: diva2:1338289
Available from: 2019-07-22 Created: 2019-07-22 Last updated: 2019-07-22Bibliographically approved

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