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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

Research output not available from this repository, contact author.
Official URL: http://dx.doi.org/10.1136/bmjopen-2017-017585

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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
Subjects: R Medicine > RD Surgery
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit
Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
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:
DateEvent
11 September 2017Available
31 July 2017Accepted
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
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIEDMedtronic International Trading SàrlUNSPECIFIED

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