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

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Author(s)

  • Sharada Weir
  • Mihail Samnaliev
  • Tzu-Chun Kuo
  • Caitriona Ni Choitir
  • Travis S Tierney
  • David Cumming
  • Julie Bruce
  • Andrea Manca
  • Rod S Taylor
  • Sam Eldabe

Department/unit(s)

Publication details

JournalBMJ Open
DateAccepted/In press - 31 Jul 2017
DatePublished (current) - 11 Sep 2017
Issue number9
Volume7
Number of pages9
Pages (from-to)1-9
Original languageEnglish

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.

Bibliographical note

© 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.

    Research areas

  • Adult, Aged, Back Pain/economics, Cohort Studies, Databases, Factual, England, Female, Health Care Costs, Hospitals, Humans, Incidence, Lumbosacral Region/surgery, Male, Middle Aged, Orthopedic Procedures/adverse effects, Pain, Postoperative/economics, Prevalence, Retrospective Studies

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