Analysis of primary referral patterns and return to work in patients with incident back pain due to lumbar disc herniation

Objective: To examine primary referral patterns and return to work in patients with incident back pain due to Lumbar Disc Herniation (LDH). Methods: Nationwide register-based cohort study including all Danish residents aged 18–65 who were referred from primary to specialized healthcare in 2017 with incident back pain and subsequently received a diagnosis of lumbar disc herniation (LDH), defined by ICD-10 codes DM51X.X. Patients were identified using the Danish National Patient Registry (DNPR), including both those directly diagnosed with LDH and those who initially received a diagnosis of nonspecific low back pain (ICD-10: DM54) that progressed to LDH within one year. Demographic data were obtained from the Danish Civil Registration System (CRS), and work capacity outcomes were assessed over a two-year follow-up using the Danish Register for Evaluation of Marginalization (DREAM). Results: A total of 30,082 persons, corresponding to 0.8% of the Danish population aged 18–65, were referred from primary health care to specialized health care with incident back pain and a final diagnosis of LDH. Of these, 5356 (17.8%) were referred to an emergency department, 14,628 (48.6%) to a medical department, and 10,098 (33.6%) to a surgical department. However, the admission rate and the initial department referred to varied widely between regions. Overall, 1915 (6.4%) underwent surgery. Surgical departments operated more frequently on patients with previous high (11%) or intermediate (14%) work capacity than on those with low work capacity (4%), although the latter were more often referred for surgical evaluation. Over 80% of patients with high or intermediate work capacity maintained or returned to work within a year. Conclusion: In Denmark, referral from primary to specialized health care of patients with incident back pain due to LDH varies considerable between regions highlighting the need for more standardized referral pathways. Specifically, ensuring a better balance between emergency, medical, and surgical referrals could reduce unnecessary emergency admissions and improve the precision of surgical referrals optimizing the use of surgical capacity and healthcare resources in general.