Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Sci Rep. 2022 Jul 27;12(1):12856. doi: 10.1038/s41598-022-17194-z.
During the last decades, there has been an increase in the rate of surgery for degenerative disorders of the cervical spine and in the use of supplementary private health insurance. Still, there is limited knowledge about the differences in characteristics of patients operated in public and private hospitals. Therefore, we aimed at comparing sociodemographic-, clinical- and patient management data on patients operated for degenerative cervical radiculopathy and degenerative cervical myelopathy in public and private hospitals in Norway. This was a cross-sectional study on patients in the Norwegian Registry for Spine Surgery operated for degenerative cervical radiculopathy and degenerative cervical myelopathy between January 2012 and December 2020. At admission for surgery, we assessed disability by the following patient reported outcome measures (PROMs): neck disability index (NDI), EuroQol-5D (EQ-5D) and numerical rating scales for neck pain (NRS-NP) and arm pain (NRS-AP). Among 9161 patients, 7344 (80.2%) procedures were performed in public hospitals and 1817 (19.8%) in private hospitals. Mean age was 52.1 years in public hospitals and 49.7 years in private hospitals (P < 0.001). More women were operated in public hospitals (47.9%) than in private hospitals (31.6%) (P < 0.001). A larger proportion of patients in private hospitals had high education (≥ 4 years of college or university) (42.9% vs 35.6%, P < 0.001). Patients in public hospitals had worse disease-specific health problems than those in private hospitals: unadjusted NDI mean difference was 5.2 (95% CI 4.4 - 6.0; P < 0.001) and adjusted NDI mean difference was 3.4 (95% CI 2.5 - 4.2; P < 0.001), and they also had longer duration of symptoms (P < 0.001). Duration of surgery (mean difference 29 minutes, 95% CI 27.1 - 30.7; P < 0.001) and length of hospital stay (mean difference 2 days, 95% CI 2.3 - 2.4; P < 0.001) were longer in public hospitals. In conclusion, patients operated for degenerative cervical spine in private hospitals were healthier, younger, better educated and more often men. They also had less and shorter duration of symptoms and seemed to be managed more efficiently. Our findings indicate that access to cervical spine surgery in private hospitals could be skewed in favour of patients with higher socioeconomic status.
在过去的几十年中，颈椎退行性疾病手术的比例以及补充私人医疗保险的使用有所增加。然而，对于在公立医院和私立医院接受手术的患者特征差异，我们的了解仍然有限。因此，我们旨在比较挪威公立医院和私立医院接受退行性颈椎神经根病和退行性颈椎脊髓病手术的患者的社会人口统计学、临床和患者管理数据。这是一项针对 2012 年 1 月至 2020 年 12 月期间在挪威脊柱外科登记处接受退行性颈椎神经根病和退行性颈椎脊髓病手术的患者的横断面研究。在手术入院时，我们使用以下患者报告的结果测量值 (PROM) 评估残疾：颈部残疾指数 (NDI)、欧洲五维健康量表 (EQ-5D) 以及颈部疼痛的数字评定量表 (NRS-NP) 和手臂疼痛 (NRS-AP)。在 9161 名患者中，7344 名（80.2%）在公立医院进行了手术，1817 名（19.8%）在私立医院进行了手术。公立医院的平均年龄为 52.1 岁，私立医院为 49.7 岁（P<0.001）。在公立医院接受手术的女性比例（47.9%）高于私立医院（31.6%）（P<0.001）。私立医院中接受过高等教育（≥4 年的学院或大学）的患者比例更高（42.9%对 35.6%，P<0.001）。与私立医院相比，公立医院的患者存在更严重的疾病特异性健康问题：未经调整的 NDI 平均差异为 5.2（95%CI 4.4-6.0；P<0.001），调整后的 NDI 平均差异为 3.4（95%CI 2.5-4.2；P<0.001），并且他们的症状持续时间也更长（P<0.001）。公立医院的手术时间（平均差异 29 分钟，95%CI 27.1-30.7；P<0.001）和住院时间（平均差异 2 天，95%CI 2.3-2.4；P<0.001）更长。总之，在私立医院接受退行性颈椎手术的患者更健康、更年轻、教育程度更高，而且更多为男性。他们的症状持续时间也更短，并且看起来管理得更有效。我们的研究结果表明，私立医院的颈椎手术机会可能偏向于社会经济地位较高的患者。
