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)

Abstract

ObjectiveTo characterise incidence and healthcare costs associated with persistent postoperative pain (PPP) following lumbar surgery.DesignRetrospective, population-based cohort study.SettingClinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases.ParticipantsPopulation-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 measuresIncidence and total healthcare costs over 2, 5 and 10 years attributable to persistent PPP following initial lumbar surgery.ResultsThe 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.ConclusionsPersistent 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.

Characterizing the Somatosensory Profile of Patients With Failed Back Surgery Syndrome With Unilateral Lumbar Radiculopathy Undergoing Spinal Cord Stimulation: A Single Center Prospective Pilot Study

“…Lumbar spine surgeries are commonly performed in patients with chronic low back pain . The International Association for the Study of Pain (IASP) define Failed Back Surgery Syndrome (FBSS) as Lumbar spinal pain of unknown origin either persisting despite surgical intervention or appearing after surgical intervention for spinal pain originally in the same topographical location .…”

The appropriate management of persisting pain after spine surgery: a European panel study with recommendations based on the RAND/UCLA method

“…Unfortunately, there is a considerable proportion of patients who experience recurrent or remaining pain following initial spine surgery, ranging from 3 to 34% at follow-up between 6 and 24 months after surgery, and 5 to 36% upon long-term evaluation (> 2 years) [3,4]. A recent populationbased cohort study in England reported that over the period 2007-2012 on average 20.8% of lumbar surgery patients experienced persistent post-operative pain [5]. Unsatisfactory results after spinal surgery are often referred to as "failed back surgery syndrome" (FBSS), but this term has been criticised because it unilaterally puts the blame on the operation as the cause of the problem, while the aetiology is much more complex and often multifactorial [6][7][8][9].…”

Predicting recovery after lumbar spinal stenosis surgery: A protocol for a historical cohort study using data from the Canadian Spine Outcomes Research Network (CSORN)

“…6 Unfortunately, significant persistent pain, functional limitations, diminished HRQoL, and narcotic use can affect up to one third of patients post-surgery. [7][8][9] More specifically, there is evidence to suggest that approximately 30% of patients do not reach minimal clinical important change in disability, pain or quality of life after 1 year post-surgery. [10][11][12] Further, a recently published large population-based study identified that more than 40% of patients undergoing fusion for SLSS remain long-term opioid users.…”