Outcomes After Lumbar Disk Herniation Surgery in the Dutch Population

Abstract

Study Design: Retrospective cohort study. Objective: There is only limited data on the outcome of primary surgery of lumbar disk herniation (LDH) in Dutch patients. The objective of this study is to describe undesirable outcomes after primary LDH. Methods: The National Claims Database (Vektis) was searched for primary LDH operations performed from July 2015 until June 2016, for reoperations within 18 months, prescription of opioids between 6 to 12 months and nerve root block within 1 year. A combined outcome measure was also made. Group comparisons were analyzed with the Student’s t-test. Results: Primary LDH surgery was performed in 6895 patients in 70 hospitals. Weighted mean of reoperations was 7.3%, nerve root block 6.7% and opioid use 15.6%. In total, 23.0% of patients had one or more undesirable outcomes after surgery. The 95% CI interval exceeded the 50% incidence line for 14 out of 26 hospitals with less than 50 surgical interventions per year. Although the data suggested a volume effect on undesired outcomes, the t-tests between hospitals with volume thresholds of 100, 150 and 200 interventions per year did not support this ( P values 0.078, 0.129, 0.114). Conclusion: This unique nationwide claims-based study provides insight into patient-relevant undesirable outcomes such as reoperation, nerve root block and opioid use after LDH surgery. About a quarter of the patients had a serious complication in the first follow up year that prompted further medical treatment. There is a wide variation in complication rates between hospitals with a trend that supports concentration of LDH care.

Variability in recovery following microdiscectomy and postoperative physiotherapy for lumbar radiculopathy: A latent class trajectory analysis

“…Prospective cohort studies have shown that most patients experience a clinically relevant improvement in pain and disability after lumbar radiculopathy following microdiscectomy, supporting the role of surgery and suggesting a favorable average course [27]. However, many patients do not fit the average trajectory profile and for some, the outcomes result in serious complications and/or long-term, persistent problems [18,27,29]. Therefore, this study aimed to explore the variability in recovery after lumbar microdiscectomy and post-operative physiotherapy by deriving and predicting outcome trajectories.…”

“…Furthermore, prior back surgery was an important predictor for the poor outcome trajectories of pain and disability in comparison with the large improved trajectory. Previous research shows there is a high risk of reoperations (0.6-24%) for patients who underwent lumbar discectomy and more than half of these patients undergo reoperation within the first two years [1,15,16,29]. Consequently, worse outcomes are reported for patients requiring multiple lumbar spine operations [16,23].…”

“…Lumbar microdiscectomy often results in an immediate clinically relevant improvement in leg pain and disability with accompanying improvements in back pain [18,27]. However, serious complications and the need for additional treatment, such as reoperation (7.3%), nerve root blocks (6.7%), or opioid use (15.6%) occur in the first year after surgery, reflecting undesirable outcomes [29]. Furthermore, most patients still experience mild to moderate pain and disability up to 7 years after surgery [18,27].…”

Validation of Claims Data for Absorbing Pads as a Measure for Urinary Incontinence after Radical Prostatectomy, a National Cross-Sectional Analysis

“…This offers the opportunity to analyze nationwide claims data within the centrally registered National Claims Database (Vektis) in which all insurance companies in the Netherlands take part. This approach has been successful in the past for quality assessment in myocardial infarction, chemotherapy and intensive care unit admissions in upper gastrointestinal cancer patients, as well as other diseases [19][20][21][22], resulting in the identification of new quality indicators. In 2018, Schepens et al evaluated the post-RP UI rate based on the claims of absorbing pads [23].…”

Diagnostic accuracy of color-coded virtual noncalcium reconstructions derived from portal venous phase dual-energy CT in the assessment of lumbar disk herniation

“…Degenerative intervertebral changes of the lumbar spine with concomitant herniation of lumbar disks represent one of the most common reasons for lower back pain and the principal cause for spinal surgery [ 1 , 2 ]. Considering that the vast majority of people sustain an episode of lower back pain once during their lifetime, early detection and treatment initiation are essential to avoid high treatment costs and poor outcome [ 3 , 4 ].…”