The Long-term Reoperation Rate Following Surgery for Lumbar Herniated Intervertebral Disc Disease

Abstract

Study Design. A retrospective cohort study of a nationwide sample database. Objective. The objective of the present study was to compare the long-term incidence of reoperation for lumbar herniated intervertebral disc disease (HIVD) after major surgical techniques (open discectomy, OD; laminectomy; percutaneous endoscopic lumbar discectomy, PELD; fusion). Summary of Background Data. HIVD is a major spinal affliction; if the disease is intractable, surgery is recommended. Considering both the aging of patients and the chronicity of lumbar degenerative disease, the effect of surgical treatment for the lumbar spine should be durable for as long as possible. Methods. The National Health Insurance Service-National Sample Cohort (NHIS-NSC) of Republic of Korea was utilized to establish a cohort of adult patients (N = 1856) who underwent first surgery for lumbar HIVD during 2005 to 2007. Patients were followed for 8 to 10 years. Considering death before reoperation as a competing event, reoperation hazards were compared among surgical techniques using the Fine and Gray regression model after adjustment for age, gender, Charlson comorbidity score, osteoporosis, diabetes, the severity of disability, insurance type, and hospital type. Results. The overall cumulative incidences of reoperation were 4% at 1 year, 6% at 2 years, 8% at 3 years, 11% at 5 years, and 16% at 10 years. The cumulative incidences of reoperation were 16%, 14%, 16%, and 10% after OD, laminectomy, PELD, and fusion, respectively, at 10 years postoperation, with no difference among the surgical techniques. However, the distribution of reoperation types was significantly different according to the first surgical technique (P < 0.01). OD was selected as the reoperation surgical technique in 80% of patients after OD and in 81% of patients after PELD. Conclusion. The probability of reoperation did not differ among OD, laminectomy, PELD, and fusion during the 10-year follow-up period. However, OD was the most commonly used technique in reoperation. Level of Evidence: 4

Direct medical costs after surgical or nonsurgical treatment for degenerative lumbar spinal disease: a nationwide matched cohort study with a 10-year follow-up

“…To the best of our knowledge, the present study is the rst to compare direct medical costs between surgery and nonsurgery under NHIS over a long-term follow-up period. 16,19 However, the present study has several limitations. As mentioned, the claim data lack detailed clinical and radiological information, which limits the direct application of the results to clinical practice.…”

“…The requirement for informed consent was waived because the data were deidenti ed, and Seoul National University College of Medicine/Seoul National University Hospital Institutional Review Board approved the review and analysis of the data (2010-076-116). All methods were carried out in accordance with relevant guidelines and regulations Data source [17][18][19] The National Health Insurance database (NHID) was developed to record the personal information, demographics and medical treatment data for all Korean citizens. 16 The disease codes were standardized based on the 10 th version of the International Classi cation of Diseases (ICD-10), and the procedure codes were standardized to the claim medical fees.…”

“…Second, only direct costs were analyzed, and indirect costs, such as missed work and medical fees for noncovered services, were not considered in this study. 19,54,57 In addition, as with most cost-effectiveness studies, speci c dollar values might not be equivalent among studies, and the WTP considering the bene ts and risks of each surgical method in different countries may lead to different interpretations. 38,44 Regardless of these limitations, the present study provides a picture of how the NHIS is utilized on a nationwide scale, and this information may be helpful for physicians, patients and policy makers for improving the NHIS.…”

Radiologic Analysis of Causes of Early Recurrence after Percutaneous Endoscopic Transforaminal Discectomy

“…The incidence of rLDH is approximately 5.7-15%. [17,18,19,20] The time period for the occurrence of rLDH is currently unde ned. One essential condition for a diagnosis of recurrence states that there must be a symptom-free period for a segment of the nerve root before postoperative symptoms appear.…”

Direct medical costs after surgical or nonsurgical treatment for degenerative lumbar spinal disease: A nationwide matched cohort study with a 10-year follow-up

“…Initially, patients were selected from the NHIS-NSC on the basis of diagnosis and surgery codes. Thereafter, the following factors were considered for matching: age, sex, diagnosis, osteoporosis without fractures and diabetes mellitus, and the total charge incurred over the previous 3 years (which was assumed to be a surrogate for disease severity) [ 9 , 10 , 13 , 14 ]. Osteoporosis and diabetes mellitus were specifically included for matching, because those factors were associated with outcomes in previous studies [ 9 , 10 , 13 , 14 ].…”