Non-respondents do not bias outcome assessment after cervical spine surgery: a multicenter observational study from the Norwegian registry for spine surgery (NORspine)

Background - The Norwegian registry for spine surgery (NORspine) is a national clinical quality registry which has recorded more than 10,000 operations for degenerative conditions of the cervical spine since 2012. Registries are large observational cohorts, at risk for attrition bias. We therefore aimed to examine whether clinical outcomes differed between respondents and non-respondents to standardized questionnaire-based 12-month follow-up. Methods - All eight public and private providers of cervical spine surgery in Norway report to NORspine. We included 334 consecutive patients who were registered with surgical treatment of degenerative conditions in the cervical spine in 2018 and did a retrospective analysis of prospectively collected register data and data on non-respondents’ outcomes collected by telephone interviews. The primary outcome measure was patient-reported change in arm pain assessed with the numeric rating scale (NRS). Secondary outcome measures were change in neck pain assessed with the NRS, change in health-related quality of life assessed with EuroQol 5 Dimensions (EQ-5D), and patients’ perceived benefit of the operation assessed by the Global Perceived Effect (GPE) scale. Results - At baseline, there were few and small differences between the 238 (71.3%) respondents and the 96 (28.7%) non-respondents. We reached 76 (79.2%) non-respondents by telephone, and 63 (65.6%) consented to an interview. There was no statistically significant difference between groups in change in NRS score for arm pain (3.26 (95% CI 2.84 to 3.69) points for respondents and 2.77 (1.92 to 3.63) points for telephone interviewees) or any of the secondary outcome measures. Conclusions - The results indicate that patients lost to follow-up were missing at random. Analyses of outcomes based on data from respondents can be considered representative for the complete register cohort, if patient characteristics associated with attrition are controlled for

The Norwegian registry for spine surgery (NORspine): cohort profile

Purpose - To review and describe the development, methods and cohort of the lumbosacral part of the Norwegian registry for spine surgery (NORspine). Methods - NORspine was established in 2007. It is government funded, covers all providers and captures consecutive cases undergoing operations for degenerative disorders. Patients’ participation is voluntary and requires informed consent. A set of baseline-, process- and outcome-variables (3 and 12 months) recommended by the International Consortium for Health Outcome Measurement is reported by surgeons and patients. The main outcome is the Oswestry disability index (ODI) at 12 months. Results - We show satisfactory data quality assessed by completeness, timeliness, accuracy, relevance and comparability. The coverage rate has been 100% since 2016 and the capture rate has increased to 74% in 2021. The cohort consists of 60,647 (47.6% women) cases with mean age 55.7 years, registered during the years 2007 through 2021. The proportions > 70 years and with an American Society of Anaesthesiologists’ Physical Classification System (ASA) score > II has increased gradually to 26.1% and 19.3%, respectively. Mean ODI at baseline was 43.0 (standard deviation 17.3). Most cases were operated with decompression for disc herniation (n = 26,557, 43.8%) or spinal stenosis (n = 26,545, 43.8%), and 7417 (12.2%) with additional or primary fusion. The response rate at 12 months follow-up was 71.6%. Conclusion - NORspine is a well-designed population-based comprehensive national clinical quality registry. The register’s methods ensure appropriate data for quality surveillance and improvement, and research

Effect of interventions to prevent depression associated with childbirth in women at risk. A systematic review and meta-analysis. Effekt av tiltak for å forebygge depresjon i forbindelse med fødsler hos kvinner i risiko. En systematisk oversikt og meta-analyse.

Background: A proportion of 10-15% of Norwegian mothers experience symptoms of depression in such an extent that they may need help. In addition to complicate life for the mother, there is a danger that the child's development may be adversely affected by the mother's condition. Objectives of the study are to determine if it can be proven difference in efficacy of interventions between two groups of women at risk, selected differently. Results and theme are discussed, related to Norwegian conditions. Methods: A literature review published by the Cochrane Library in 2013 concluded that several types of interventions reduced the incidence of depression, particularly for women at risk. A supplementary systematic search of scientific literature is performed. Meta- analysis is used to find answer to the research question. Results: As a result of the systematic literature search, two more scientific papers were detected. Combined with the seven articles from the original search, it was a total of nine. These studies involved over 2600 women. Meta-analysis showed that there was no significant difference in efficacy between the two different groups. Constituent material gave no basis for making moderator analysis. Conclusion: This study indicates that there is no significant difference in the efficacy of interventions if one selects women at risk by risk factors in general, or as a result of elevated total-score of a mapping. There are many questions that should be clarified in the work of uncovering and preventing depression in women during pregnancy and births in Norway. In particular the focus on measures that specifically improves infant’s development conditions must be increased