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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)
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Weir, Sharada, Samnaliev, Mihail, Kuo, Tzu-Chun, Ni Choitir, Caitriona, Tierney, Travis S., Cumming, David, Bruce, Julie, Manca, Andrea, Taylor, Rod S. and Eldabe, Sam (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). BMJ Open, 7 (9). e017585. doi:10.1136/bmjopen-2017-017585 ISSN 2044-6055.
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Official URL: http://dx.doi.org/10.1136/bmjopen-2017-017585
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 pound (95% CI 4872 pound to 5916) pound. Over 5 and 10 years following initial spine surgery, the mean cost difference between patients with and without PPP increased to 10 pound 195 (95% CI 8726 pound to 11 pound 669) and 14 pound 318 (95% CI 8386 pound to 19 pound 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 pound 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.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RD Surgery | ||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Spine -- Surgery, Postoperative pain -- Economic aspects, Postoperative pain -- Costs | ||||||
| Journal or Publication Title: | BMJ Open | ||||||
| Publisher: | BMJ | ||||||
| ISSN: | 2044-6055 | ||||||
| Official Date: | 11 September 2017 | ||||||
| Dates: |
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| Volume: | 7 | ||||||
| Number: | 9 | ||||||
| Page Range: | e017585 | ||||||
| DOI: | 10.1136/bmjopen-2017-017585 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| RIOXX Funder/Project Grant: |
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