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. 2017 Sep 11;7(9):e017585. doi: 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 (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.

MeSH terms

  • 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*
  • Orthopedic Procedures / trends
  • Pain, Postoperative / economics*
  • Pain, Postoperative / epidemiology
  • Prevalence
  • Retrospective Studies