Poster Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

A comparison of surgical outcome and equitable access for hip, knee and lumbar spine surgery for endstage osteoarthritis (#176)

Y. Raja Rampersaud 1 2 3 , Anthony Perruccio 1 2 4 , Nizar Mahomed 1 2 3 , Mayilee Canizares 1
  1. Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
  2. Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
  3. Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  4. Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

Introduction: The population rate of spine surgery for symptomatic spinal facet osteoarthritis (OA) causing lumbar spinal stenosis compared to similar OA related hip and knee replacements is highly variable across jurisdictions. Our objective was to compare health related quality of life (HRQoL) pre- and 1-year post- hip, knee and lumbar spine surgery for OA, and describe time trends in volume and rates of surgery for OA in Ontario, Canada.

Methods: Data sources: Canadian Research Network and Spine Outcomes (CSORN) registry (lumbar degenerative spondylolisthesis-LDS); LEAP-OA study (hip and knee OA); and Discharge Abstract Database for volume and rate of surgery. We compared the overall and age-sex specific means (SD) of the physical component score (PCS) from the SF-12 to the corresponding matched estimates from the Canadian general population (CGP). We also compared PCS values from baseline to 1-year post-surgery by surgical joint adjusting for age, sex, and comorbidities using multiple linear regression. We described the volume and age-sex adjusted rates of in-patient surgery for hip, knee, and spine OA from 2004 to 2019. Hip and knee OA surgeries were identified using ICD-10 primary/most responsible discharge diagnosis codes M16-M17; while surgeries for spinal OA were identified using ICD-10 codes M47 and M48.0.

Results: We analysed data on 1136 CSORN LDS patients, and 788 hip and 1071 knee LEAP-OA patients. Pre- and 1-year post-surgery PCS means (SD) were 28.7 (7.5) vs. 40.5 (10.9) for spine, 30.7 (10.7) vs 44.8 (11.4) for hip, and 31.5 (10.5) vs 41.0 (12.1) for knee, compared to 50.5 (9.0) for the CGP (Figure 1). Controlling for age, sex, and comorbidities, PCS improvements were statistically significant and of the same magnitude across surgical groups (p<0.0001). From 2004 to 2019, the number of spine surgeries (from 1800 to 1900) remained stable, while there was a 60% increase in hip surgery volumes (7500 to 12000), and a 63% increase in knee surgery volumes (12500 to 18400). The age-sex adjusted rates per 100,000 population slightly declined for spine (from 12.9 to 10.7) and increased for knee (83.6 to 117.4) and hip (51.1 to 67.9) surgeries (Figure 2).

Discussion: Hip, knee and spine surgery for OA are associated with a dramatic and similar degree of improvement in HRQoL, and to within 1 standard deviation of age-sex CGP values. Despite similar population prevalence and outcomes there is gross inequity in access to spine surgery for OA in Ontario.

 

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