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The incidence and healthcare costs of persistent postoperative pain following lumbar spine surgery in the UK: a cohort study using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) - PubMed

  • ️Sun Jan 01 2017

The incidence and healthcare costs of persistent postoperative pain following lumbar spine surgery in the UK: a cohort study using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES)

Sharada Weir et al. BMJ Open. 2017.

Abstract

Objective: To characterise incidence and healthcare costs associated with persistent postoperative pain (PPP) following lumbar surgery.

Design: Retrospective, population-based cohort study.

Setting: Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases.

Participants: Population-based cohort of 10 216 adults who underwent lumbar surgery in England from 1997/1998 through 2011/2012 and had at least 1 year of presurgery data and 2 years of postoperative follow-up data in the linked CPRD-HES.

Primary and secondary outcomes measures: Incidence and total healthcare costs over 2, 5 and 10 years attributable to persistent PPP following initial lumbar surgery.

Results: The rate of individuals undergoing lumbar surgery in the CPRD-HES linked data doubled over the 15-year study period, fiscal years 1997/1998 to 2011/2012, from 2.5 to 4.9 per 10 000 adults. Over the most recent 5-year period (2007/2008 to 2011/2012), on average 20.8% (95% CI 19.7% to 21.9%) of lumbar surgery patients met criteria for PPP. Rates of healthcare usage were significantly higher for patients with PPP across all types of care. Over 2 years following initial spine surgery, the mean cost difference between patients with and without PPP was £5383 (95% CI £4872 to £5916). Over 5 and 10 years following initial spine surgery, the mean cost difference between patients with and without PPP increased to £10 195 (95% CI £8726 to £11 669) and £14 318 (95% CI £8386 to £19 771), respectively. Extrapolated to the UK population, we estimate that nearly 5000 adults experience PPP after spine surgery annually, with each new cohort costing the UK National Health Service in excess of £70 million over the first 10 years alone.

Conclusions: Persistent pain affects more than one-in-five lumbar surgery patients and accounts for substantial long-term healthcare costs. There is a need for formal, evidence-based guidelines for a coherent, coordinated management strategy for patients with continuing pain after lumbar surgery.

Keywords: Failed Back Surgery Syndrome (FBSS); Persistent post-operative pain (PPP); clinical practice research datalink (cprd); hospital episode statistics (hes); lumbar surgery.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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Conflict of interest statement

Competing interests: At the time of the study, CNC was employed by PHMR, LLC, who received consulting fees from Medtronic. SW, MS and T-CK received consulting fees from PHMR, LLC. RT, AM, JB, DC and SE received consulting fees from Medtronic as advisors to the project.

Figures

Figure 1
Figure 1

Age-adjusted and sex-adjusted incidence of lumbar surgery in linked Clinical Practice Research Datalink–Hospital Episode Statistics, rates per 10 000 adults.

Figure 2
Figure 2

Percentage of patients with postoperative pain (PPP) by year of index lumbar surgery. HES, Hospital Episode Statistics.

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