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dc.contributor.authorMadsbu, Mattis Aleksander
dc.contributor.authorSalvesen, Øyvind
dc.contributor.authorCarlsen, Sven Magnus
dc.contributor.authorWestin, Steinar
dc.contributor.authorOnarheim, Kristian
dc.contributor.authorNygaard, Øystein Petter
dc.contributor.authorSolberg, Tore
dc.contributor.authorGulati, Sasha
dc.identifier.citationActa Neurochirurgica. 2020, 162 (3), 703-711.en_US
dc.description.abstractBackground 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.en_US
dc.rightsNavngivelse 4.0 Internasjonal*
dc.titleSurgery for herniated lumbar disc in private vs public hospitals: A pragmatic comparative effectiveness studyen_US
dc.typePeer revieweden_US
dc.typeJournal articleen_US
dc.source.journalActa Neurochirurgicaen_US
dc.description.localcodeC The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

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Navngivelse 4.0 Internasjonal
Except where otherwise noted, this item's license is described as Navngivelse 4.0 Internasjonal