{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T10:45:16Z","timestamp":1791542716620,"version":"4.3.4"},"reference-count":27,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T00:00:00Z","timestamp":1710115200000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"the Netherlands Organization for Health Research and Development","doi-asserted-by":"crossref","award":["839205002"],"award-info":[{"award-number":["839205002"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,1,22]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The aim of this study was to assess the impact of high-quality evidence supporting surgical treatment of lumbar disc herniation (LDH) on healthcare practice in the Netherlands by examining changes in healthcare utilisation, including the timing of surgery, and the healthcare costs for patients with LDH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective, cross-sectional study was performed using population-based, longitudinal data obtained from the Dutch Healthcare Authority (2007\u20132020) and NIVEL\u2019s primary care (2012\u20132020) administrative databases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study was conducted within the healthcare system of the Netherlands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>We included adults (\u226518 years) who visited a Dutch hospital or a general practitioner (GP) for lumbar degenerative disc disease. Patients with LDH were identified based on registered diagnosis code, type of surgery (discectomy) and age (&lt;56 years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcome measure was the difference in the annual number of LDH procedures following the publication of evidence-based guidelines in 2009 (comparing the periods 2007\u20132009 to 2017\u20132019). Secondary outcome measures focused on the timing of surgery and associated healthcare costs. To validate the outcomes, secondary outcomes also include the number of discectomies and the number of procedures in the younger age group (discectomies, laminectomies, and fusion surgery).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The number of patients suffering from LDH increased from 55 581 to 68 997 (+24%) between 2007 and 2019. A decrease was observed in the annual number of LDH procedures (\u221218%), in the number of discectomies (\u221222%) and in the number of procedures for patients aged &lt;56 years (\u221218%). This resulted in lower healthcare costs by \u20ac10.5 million annually. In 2012, 31% of all patients &lt;56 years had surgery before 12 weeks from diagnosis at the GP, whereas 20% did in 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Healthcare utilisation for LDH changed tremendously in the Netherlands between 2007 and 2020 and seemed to be associated with the publication and implementation of evidence-based guidelines. The observed decrease in the number of procedures has been accompanied by a corresponding reduction in healthcare costs. These findings underscore the importance of adhering to evidence-based guidelines to optimise the management of patients with LDH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-078459","type":"journal-article","created":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T02:41:26Z","timestamp":1710211286000},"page":"e078459","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of evidence-based guidelines on healthcare utilisation and costs for disc related sciatica in the Netherlands: a population-based, cross-sectional study"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1670-1800","authenticated-orcid":false,"given":"Juli\u00ebtte","family":"van Munster","sequence":"first","affiliation":[{"name":"Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark W","family":"Noordenbos","sequence":"additional","affiliation":[{"name":"Dutch Healthcare Authority, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I J Y","family":"Halperin","sequence":"additional","affiliation":[{"name":"Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilbert B","family":"van den Hout","sequence":"additional","affiliation":[{"name":"Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter Paul","family":"van Benthem","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Seinen","sequence":"additional","affiliation":[{"name":"Dutch Healthcare Authority, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wouter A","family":"Moojen","sequence":"additional","affiliation":[{"name":"Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands"},{"name":"Neurosurgery, HAGA hospital, The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilco","family":"Peul","sequence":"additional","affiliation":[{"name":"Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,3,11]]},"reference":[{"key":"2025121512362179000_14.3.e078459.1","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1177\/2192568218770769","article-title":"Degenerative lumbar spine disease: estimating global incidence and worldwide volume","volume":"8","author":"Ravindra","year":"2018","journal-title":"Global Spine J"},{"key":"2025121512362179000_14.3.e078459.2","first-page":"45","article-title":"Westeinde sciatica trial: randomized controlled study of bed rest and physiotherapy for acute sciatica","volume":"96","author":"Hofstee","year":"2002","journal-title":"J Neurosurg"},{"key":"2025121512362179000_14.3.e078459.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1912658"},{"key":"2025121512362179000_14.3.e078459.4","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199405310-00001"},{"key":"2025121512362179000_14.3.e078459.5","unstructured":"Gezondheidsraad . 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