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Surgery for herniated lumbar disc in public vs private hospitals: a pragmatic comparative effectiveness study
EANS Academy. Madsbu M. Sep 27, 2019; 276058; EP02070
Dr. Mattis Aleksander Madsbu
Dr. Mattis Aleksander Madsbu

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Abstract
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Background: In times of economic recession with major constraints on government budgets, disputes between the proponents of private and public systems tend to escalate. There is currently limited and poor-quality evidence base regarding the comparative performance of the two systems.The aim of this study was to compare patient-reported outcomes following surgery for herniated lumbar disc in public versus private hospitals.
Methods: The primary outcome was change in Oswestry disability index score one year after surgery. Secondary endpoints were quality of life (EuroQol EQ-5D), perioperative complications, and duration of surgical procedures and hospital stays. A biostatistician performed predefined statistical analyses in unmatched and propensity matched cohorts.
Results: 5521 patients were included. 3620 patients (69.3%) completed the one year follow-up. Equivalence between patients operated in private and public clinics was shown for the Oswestry disability index (difference 3.5 points, 95% CI 1.9 to 5.0, P< 0.001 for equivalence). Equivalence was confirmed in the propensity matched cohort. There was a small difference in mean change between the groups in the aggregate cohort in quality of life (EQ-5D) and back pain (0.45 vs 0.50 95% CI 0.05, 0.02 to 0.08, P=0.002) and (3.31 vs 3.5, 95% CI 0.22, 0.001 to 0.44, P=0.049). After propensity matching the groups did not differ (0.46 vs 0.42, P=0.13) and (3.4 vs 3.2, P=0.16). The number of patients with complications was higher in the public group in the aggregate cohort compared to the private group (7.2% v 4.5%, P< 0.001). After propensity matching, there was no difference (6.2 v 4.7, P=0.1). The patients operated in private clinic had shorter operation time (48.4 v 61.8) and fewer days in hospital following surgery (0.7 v 2.2). This was confirmed in the propensity matched cohort.
Conclusion: The effectiveness of microdecompression was equivalent for patients operated in both private and public hospitals.
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