Cervical spine surgery in the Northern Norway Regional Health Authority area in 2014-18. / Nakkekirurgi i Helse Nord 2014­18.

BACKGROUND: Knowledge about the variation in treatment rates is needed to assess whether the access to health services is equitable. The objective of this study was to investigate the rates of surgical treatment of degenerative cervical spine disease in Norway and the Northern Norway Regional Health Authority area and the local coverage in the Northern Norway Regional Health Authority area, and to assess the activity in the region. MATERIAL AND METHOD: We included cervical spine procedures recorded in the Norwegian Patient Registry from the years 2014-18 and estimated age-standardised treatment rates for Norway, the health regions and health trusts in Northern Norway Regional Health Authority. We estimated the local coverage as the proportion of patients resident in the Northern Norway Regional Health Authority area who had undergone surgery at the University Hospital of North Norway in Tromsø. RESULTS: The treatment rate remained stable at an average of 29.6 surgical procedures per 100 000 inhabitants (aged 18-105) per year. The rate for residents in the Northern Norway Regional Health Authority area was 23.0 procedures per 100 000 inhabitants per year (78 % of the national average). The rates in Finnmark and the areas of residence served by the University Hospital of North Norway were close to the national average. Residents in the Nordland and Helgeland areas had lower rates in each year of the study period, with an average of 16.6 and 18.1 procedures per 100 000 inhabitants per year respectively. This corresponds to 56 % and 61 % of the national average. Local coverage in the Northern Norway Regional Health Authority area increased from 69 % in 2014 to 91 % in 2018. INTERPRETATION: The treatment rate for degenerative cervical spine disease was lower in the Northern Norway Regional Health Authority area than in the rest of Norway. For this to be compensated and the local coverage to be increased to 100 %, we have estimated that the activity needs to be increased by approximately 35 surgical procedures per year.

Treatment rates for lumbar spine surgery in Norway and Northern Norway Regional Health Authority 2014-18. / Behandlingsrater for ryggkirurgi i Norge og Helse Nord 2014­18.

BACKGROUND: The objective of this study was to investigate whether the service provision for lumbar spine surgery within the Northern Norway Regional Health Authority area complies with the distribution of functions that has been decided for the hospitals in the region, and whether there are any geographical variations in service provision. We therefore studied the treatment rates in Norway as a whole and in the Northern Norway Regional Health Authority area, and assessed the activity in the region. MATERIAL AND METHOD: We included lumbar spine procedures in the Norwegian Patient Registry from the years 2014-2018 in a retrospective analysis and estimated treatment rates standardised by sex and age for Norway as a whole, the health regions and the health enterprises in Northern Norway Regional Health Authority. We estimated the local coverage as the proportion of patients who had undergone surgery in a hospital within their own area of residence. RESULTS: The treatment rate for lumbar spine surgery in Norway amounted to approximately 120 procedures per 100 000 inhabitants per year for the entire period. The number of spine procedures nationwide increased from 5 995 in 2014 to 6 494 in 2018 because of a general population growth. The treatment rates for fractures and simple spine procedures were approximately identical throughout Norway, but the rate for complex spine procedures among residents within the area of Northern Norway Regional Health Authority amounted to 57 % of the national average. Local coverage within the Northern Norway Regional Health Authority area increased from 60 % to 84 % during the period. The local hospital functions for simple spine procedures at Nordland and Helgeland hospitals (approximately 30 %) and the regional function for complex spine surgery at the University Hospital of North Norway (55 %) had a low degree of local coverage. INTERPRETATION: The treatment rate for complex spine procedures and the local coverage for all surgical procedures for degenerative lumbar spine disease were lower within the Northern Norway Regional Health Authority area than in the country as a whole. For this to be compensated in this region, we have estimated that the activity needs to be increased by approximately 170 procedures per year.