Surgery for herniated lumbar disc in private vs public hospitals: A pragmatic comparative effectiveness study

Abstract

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 followup. 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.

Surgery for Degenerative Cervical Myelopathy: A Nationwide Registry-Based Observational Study With Patient-Reported Outcomes

“…NORspine is a comprehensive registry for quality control and research and includes all eight centers performing cervical spine surgery in Norway. 16 , 17 Currently, approximately 81% of patients who undergo surgery in the cervical spine in Norway are included in NORspine. The inclusion rate for DCM surgery is probably higher as these procedures typically are scheduled.…”

A prognostic model for failure and worsening after lumbar microdiscectomy: a multicenter study from the Norwegian Registry for Spine Surgery

“…In Norway, public health insurance is compulsory; thus, no distinction was made between public or private insurance, or between public and private hospitals. A recent study has shown equivalent effectiveness of lumbar disc surgery between the public and private sector [ 21 ]. Patients were also asked if they had a pending or unresolved claim or litigation issue (yes/no) against (1) the Norwegian public welfare agency fund concerning permanent disability pension or (2) a compensation claim against private insurance companies or the public Norwegian System of Compensation to Patients.…”

Geographical variation in common orthopedic procedures in Norway: a cross-sectional population based study of 175,973 procedures

“…Accordingly, absence of data on privately funded activity is a limitation in our analysis, as the data re ects most but not all activity. For some of the studied procedures, private activity has been reported to increase variation (3,11). Further, the number of hospitals is a crude measure, as it does not account for differences in hospital capacity.…”

“…These hospitals do not report activity data to the national registry. The quality of treatment is considered equivalent in public and private hospitals, and the presumption is backed by a recent study showing equivalent effectiveness of spine surgery in public and private hospitals (11).…”