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)

Weir, S., Samnaliev, M., Kuo, T.-C., Ni Choitir, C., Tierney, T. S., Cumming, D., Bruce, J., Manca, A., Taylor, R. S. and Eldabe, S. (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) (PMID:28893756) (PMCID:PMC5595197)

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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Taylor, Professor Rod
• Authors: Weir, S., Samnaliev, M., Kuo, T.-C., Ni Choitir, C., Tierney, T. S., Cumming, D., Bruce, J., Manca, A., Taylor, R. S., and Eldabe, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: BMJ Open
• Publisher: BMJ Publishing Group
• ISSN: 2044-6055
• ISSN (Online): 2044-6055
• Published Online: 11 September 2017
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in BMJ Open 7(9):e017585
• Publisher Policy: Reproduced under a Creative Commons License