Surgery for herniated lumbar disc in private vs public hospitals: A pragmatic comparative effectiveness study.
Adult
Female
Hospitals, Private
/ statistics & numerical data
Hospitals, Public
/ statistics & numerical data
Humans
Intervertebral Disc Degeneration
/ surgery
Intervertebral Disc Displacement
/ surgery
Length of Stay
/ statistics & numerical data
Lumbar Vertebrae
/ surgery
Male
Middle Aged
Neurosurgical Procedures
/ adverse effects
Norway
Postoperative Complications
/ epidemiology
Quality of Life
Treatment Outcome
Intervertebral disc displacement
Neurosurgery
Orthopedics
Public health
Sciatica
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
14
11
2019
accepted:
20
12
2019
pubmed:
7
1
2020
medline:
3
11
2020
entrez:
6
1
2020
Statut:
ppublish
Résumé
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. 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. Among 5221 patients, 1728 in the private group and 3493 in the public group, 3624 (69.4%) completed 1-year follow-up. 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). At 1 year, the effectiveness of surgery for LDH was equivalent in private and public hospitals.
Sections du résumé
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 follow-up. 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.
Identifiants
pubmed: 31902004
doi: 10.1007/s00701-019-04195-7
pii: 10.1007/s00701-019-04195-7
pmc: PMC7046569
doi:
Types de publication
Comparative Study
Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
703-711Références
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