Characteristics and predicted outcome of patients lost to follow-up after degenerative lumbar spine surgery

• Published in: European spine journal Vol. 29; no. 12; pp. 3063 - 3073
• Main Authors: Parai, C., Hägg, O., Willers, C., Lind, B., Brisby, H.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-12-2020; Springer Nature B.V
• Subjects: Attrition; Back surgery; bias; Bone surgery; Degenerative disc disease; Intervertebral discs; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Neurosciences & Neurology; Neurosurgery; Non-response to follow-up; Original Article; Orthopedics; Ortopedi; Pain; Patients; Quality register; Regression analysis; Spinal stenosis; Spine (lumbar); Spine surgery; Surgical Orthopedics; Attrition bias; Quality register; Non-response to follow-up; Spine surgery
• ISSN: 0940-6719; 1432-0932; 1432-0932
• DOI: 10.1007/s00586-020-06528-y

Purpose
The relatively large number of participants lost to follow-up (attrition) in spinal registers calls for studies that investigate the features of these individuals and their possible outcome. The aim was to explore the effect of attrition on patient-reported outcome in patients undergoing degenerative lumbar spine surgery. Three groups were studied: spinal stenosis (LSS), disc herniation (LDH) and degenerative disc disorder (DDD).
Methods
Patients who underwent surgery for degenerative lumbar spine conditions during 2008–2012 according to registration in the Swespine national register were eligible for the study. Non-respondents were registered in Swespine prior to surgery, but not at follow-up. Swespine data were merged with hospital data from seven Swedish regions (65% of the population), Statistics Sweden, the National Patient Register and the Social Insurance Agency.
Baseline characteristics of non-respondents were described and compared to those of the respondents. Coefficients from regression analyses on PROM values for respondents were used to estimate the levels of PROM values for non-respondents, assuming the same effects of baseline characteristics for the two subgroups. Regression analyses were then conducted to identify variables associated with non-response. The results from the regression analyses were used to predict outcomes for patients with the characteristics of a non-respondent. Primary outcome variable in LSS and LDH was Global Assessment for leg pain, and in DDD, Global Assessment for back pain.
Results
Age, sex, educational level, smoking, living alone, being born outside the EU, previous spine surgery and unexpected events before follow-up were factors that were significantly associated with non-response. Being born inside, the EU was important in all of the studied groups (LSS: OR 0.61
p
 =  < 0.000; LDH: OR 0.68
p
 = 0.001; DDD: OR 0.58
p
 = 0.04). For spinal stenosis patients, an unexpected event appeared particularly important (OR 3.40,
p
 = 0.000). The predicted outcome of non-respondents was significantly worse than for respondents (LSS: 75.4% successful outcome vs. 78.7%; LDH: 53.9% vs. 58.2%; DDD: 62.7% vs. 67.5%. P-value in all groups =  < 0.000).
Conclusion
Attrition in Swespine cannot be ignored, as non-respondents were predicted to have worse outcome. The effect of attrition bias should always be considered when contemplating outcome recorded in a quality register with patients lost to follow-up.