Årsrapport 2024 Nasjonalt kvalitetsregister for ryggkirurgi: Resultater og forbedringstiltak

The Norwegian Registry for Spine Surgery (NORSpine) consists of three sub-registers for surgical treatment of degenerative conditions in the lumbar- and cervical spine, and deformity surgery (idiopathic scoliosis). All Norwegian surgical units performing these types of surgery report to the NORspine (100 % coverage). The capture rate (case completeness) is > 80 % for both lumbar and cervical spine surgery, and > 80 % of the patients respond at the 3- and 12 months follow up. However, at some hospitals the regitstration completeness should be increased. For the newly started registry for deformity (2023), completeness analyses are currently not available. The average frequency of surgery for degenerative spine conditions is stable. However, only 68 % of the lumbar and 82 % of the cervical spine cases originating from residential area of the Northern Norway regional health authority, were operated at hospitals located inside this region. Surgical outcomes vary according to diferences in patient populations. Importantly, comparison of results across surgical units, presented in this report, have not been adjusted for case-mix, even though diferences in patient populations may be large, especially between private and public hospitals. Waiting time before surgery has impact on treatment quality, but it is too long in many hospitals. From 2022 NORspine has focused on unwarranted practice variation in the use of prophylactic anti thrombotic treatment, and this has been reduced according to national recommendations. In 2024, only < 5 % could have received such medication inappropriately. After many years working with research driven quality improvement by NORspine, the use complex fusion surgery for lumbar spinal stenosis with concomitant degenerative spondylolisthesis has decreased and has now stabilized at a rate of only 7 %. The clinical outcomes 12 months after surgery remain stable, while costs have been reduced. Endoscopic spine surgery is being implemented at fve hospitals and is under consideration at several other hospitals. The number of endoscopic procedures has increased from 0 in 2019, to 83 lumbar- and to 33 cervical spine operations in 2024. A mini-Health Technology Assessment (HTA) of endoscopic spine surgery is being conducted at Telemark Hospital Trust, and possibly, also a national HTA will be developed. The NORspine is monitoring the implantation of endoscopic surgery prospectively. So far it seems to be safe compared to standard microsurgical techniques. Despite an aging patient population (30 % > 70 years), the main clinical outcomes are stable. In 2024, the proportion of patients experiencing substantial improvement 12 months after surgery (“success rate”) was 67 % for lumbar disc herniation, 63 % for lumbar spinal stenosis surgery and 59 % for anterior cervical discectomy. However, the results vary between hospitals. Better patient selection for surgery seems to be the key to further improvements. Therefore, the advisory board of the NORspine recommended several hospitals to critically appraise surgical indications and to initiate clinical audits and action at the hospitals. In 2024, seven local quality projects were ongoing. In addition, the NORspine is working with integrating the registry into the electronic patient record (DIPS), so that data concerning treatment quality can be made accessible in the clinicians’ work-fow. This enables use of artifcial intelligence-based decision support, which is expected to facilitate patient selection for surgery. This has can potentially improve patient outcomes. Clinical testing will start in 2025.