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The Rates of LSS Surgery in Norwegian Public Hospitals

A Threefold Increase From 1999 to 2013

Grøvle, Lars, MD, PhD; Fjeld, Olaf Randall, MD†,‡,§; Haugen, Anne Julsrud, MD, PhD; Helgeland, Jon, MSc; Småstuen, Milada Cvancarova, PhD†,||; Solberg, Tore Kristian, MD, PhD∗∗,††,‡‡; Zwart, John-Anker, MD, PhD§,§§; Grotle, Margreth, PT, PhD†,||

doi: 10.1097/BRS.0000000000002858
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Study Design. Retrospective administrative database study.

Objective. To assess temporal and regional trends, and length of hospital stay, in lumbar spinal stenosis (LSS) surgery in Norwegian public hospitals from 1999 to 2013.

Summary of Background Data. Studies from several countries have reported increasing rates of LSS surgery over the last decades. No such data have been presented from Norway.

Methods. A database consisting of discharges from all Norwegian public hospitals was established. Inclusion criteria were discharges including a surgical procedure of lumbar spinal decompression and/or fusion in combination with an International Statistical Classification of Diseases and Related Health Problems, 10th Revision diagnosis of Spinal Stenosis (M48.0) or Other Spondylosis with Radiculopathy (M47.2), and a patient age of 18 years or older. Discharges with diagnoses indicating deformity, that is, spondylolisthesis or scoliosis were not included.

Results. During the 15-year period, 19,543 discharges were identified. The annual rate of decompressions increased from 10.7 to 36.2 and fusions increased from 2.5 to 4.4 per 100,000 people of the general Norwegian population. The proportion of fusion surgery decreased from 19.3% to 10.9%. Among individuals older than 65 years, the annual rate of surgery per 10,000, including both decompressions and fusions, more than quadrupled from 40.2 to 170.3. The regional variation was modest, differing with a factor of 1.4 between the region with the highest and the lowest surgical rates. The mean length of hospital stay decreased from 11.0 (standard deviation 8.0) days in 1999 to 5.0 (4.6) days in 2013, but patients who received fusion surgery stayed on average 3.6 days longer than those who received decompression only.

Conclusion. The rate of LSS surgery more than tripled in Norway from 1999 to 2013. The mean length of hospital stay was reduced from 11 to 5 days.

Level of Evidence: N/A

From 1999 to 2013, the annual rates of surgery for lumbar spinal stenosis in Norwegian public hospitals more than tripled. The mean length of hospital stay decreased from 11 to 5 days, but patients who received fusion surgery stayed on average 3.6 days longer than those who received decompression only.

Department of Rheumatology, Østfold Hospital Trust, Grålum, Norway

Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway

Department of Neurology, Oslo University Hospital, Oslo, Norway

§Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway

Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway

||Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway

∗∗Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsø, Norway

††Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway

‡‡Institute of Clinical Medicine, The Arctic University (UiT) of Norway, Tromsø, Norway

§§Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.

Address correspondence and reprint requests to Lars Grøvle, MD, PhD, Revmatologisk Avdeling, Sykehuset Østfold, PB 300, 1714 Grålum, Norway; E-mail: lars.grovle@so-hf.no

Received 21 June, 2018

Revised 7 August, 2018

Accepted 9 August, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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