Norwegian study shows equivalent clinical outcomes between public and private hospitals for cervical radiculopathy surgery

Elisabet Danielsen

Despite a shorter duration of surgery and hospital stay in a private setting, the clinical effectiveness of surgery for degenerative cervical radiculopathy performed in public and private hospitals was equivalent 12 months after surgery. This is the key takeaway from a Norwegian study, the findings of which were published by Elisabet Danielsen (UiT The Arctic University of Norway, Tromsø, Norway) et al in The Bone and Joint Journal, and which also highlighted that private supplement of cervical spinal surgery has increased due to capacity shortages in public hospitals.

The researchers note that “in many countries, public hospitals have limited capacity. This has resulted in long waiting times for elective treatment and a need for supplementary private healthcare. It is uncertain whether the management of patients and the outcome of treatment are equivalent in public and private hospitals.”

As such, Danielsen et al sought to compare the management and patient-reported outcomes among patients who underwent surgery for degenerative cervical radiculopathy in public and private hospitals in Norway, and to assess whether the effectiveness of the treatment was equivalent.

The comparative study utilised prospectively collected data from the Norwegian Registry for Spine Surgery. A total of 4,750 consecutive patients who underwent surgery for degenerative cervical radiculopathy and were followed for 12 months were included. Case-mix adjustment between those managed in public and private hospitals was performed using propensity score matching.

The primary outcome measure was the change in the Neck Disability Index (NDI) between baseline and 12 months postoperatively. A mean difference in improvement of the NDI score between public and private hospitals of ≤15 points was considered equivalent.

Secondary outcome measures were a numerical rating scale for neck and arm pain and the EuroQol five-dimension three-level health questionnaire. The duration of surgery, length of hospital stay, and complications were also recorded.

The mean improvement from baseline to 12 months postoperatively of patients who underwent surgery in public and private hospitals was equivalent, both in the unmatched cohort (mean NDI difference between groups 3.9 points [95% confidence interval (CI) 2.2 to 5.6]; p<0.001) and in the matched cohort (4 points [95% CI 2.3 to 5.7]; p<0.001). In addition, secondary outcomes showed similar results.

The duration of surgery and length of hospital stay were significantly longer in public hospitals. Those treated in private hospitals reported significantly fewer complications in the unmatched cohort, but not in the matched cohort.

Speaking to Spinal News International, Danielsen said: “Our study is important because it shows that patients operated in public hospitals, despite being older and having more comorbidities, have similar outcomes 12 months after surgery when compared with patients operated in private hospitals. This is interesting because public and private hospitals receive two very different patient populations, but produce similar outcomes.

“I hope these results can give valuable information to healthcare providers and policymakers, and that they can be used to organise our healthcare system better and improve the quality of the care we provide our patients.”


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