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)

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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.

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Most cited references 25

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Preoperative anxiety and catastrophizing: a systematic review and meta-analysis of the association with chronic postsurgical pain.

Maurice Theunissen, Madelon Peters, Julie Bruce … (2015)

Anxiety and pain catastrophizing predict acute postoperative pain. However, it is not well established whether they also predict chronic postsurgical pain (CPSP). The aim of this systematic review and meta-analysis was to investigate whether high levels of preoperative anxiety or pain catastrophizing are associated with an increased risk of CPSP. Electronic search databases included PubMed and PsychINFO. Additional literature was obtained by reference tracking and expert consultation. Studies from 1958 until October 2010, investigating the association between preoperative anxiety or pain catastrophizing and CPSP in adult surgery patients, were assessed. The primary outcome was the presence of pain at least 3 months postoperatively. Twenty-nine studies were included; 14 instruments were used to assess anxiety or pain catastrophizing. Sixteen studies (55%) reported a statistically significant association between anxiety or pain catastrophizing and CPSP. The proportion of studies reporting a statistically significant association was 67% for studies of musculoskeletal surgery and 36% for other types of surgery. There was no association with study quality, but larger studies were more likely to report a statistically significant relationship. The overall pooled odds ratio, on the basis of 15 studies, ranged from 1.55 (95% confidence interval, 1.10-2.20) to 2.10 (95% confidence interval, 1.49-2.95). Pain catastrophizing might be of higher predictive utility compared with general anxiety or more specific pain-related anxiety. There is evidence that anxiety and catastrophizing play a role in the development of CPSP. We recommend that anxiety measures should be incorporated in future studies investigating the prediction and transition from acute to chronic postoperative pain.

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Failed back surgery syndrome.

Philip Peng, Chin-Feng Chan (2011)

Failed back surgery syndrome (FBSS) is a chronic pain condition that has considerable impact on the patient and health care system. Despite advances in surgical technology, the rates of failed back surgery have not declined. The factors contributing to the development of this entity may occur in the preoperative, intraoperative, and postoperative periods. Due to the severe pain and disability this syndrome may cause, more radical treatments have been utilized. Recent trials have been published that evaluate the efficacy and cost-effectiveness of therapeutic modalities such as spinal cord stimulation for the management of patients with failed back surgery. This article will describe the epidemiology and etiology of FBSS. The importance of prevention will be emphasized. In those patients with established FBSS, a guide to interdisciplinary evaluation and management will be outlined. Special attention will focus on recent trials that have studied the efficacy of more invasive procedures such as spinal cord stimulation. Finally, a suggested management pathway is presented. FBSS is a challenging clinical entity with significant impact on the individual and society. To better prevent and manage this condition, knowledge of the factors contributing to its development is necessary. While research on FBSS has increased in recent years, perhaps the best strategy to reduce incidence and morbidity is to focus on prevention. Patients diagnosed with FBSS should be managed in an interdisciplinary environment. More radical treatments for FBSS have now been extensively studied providing clinicians with much needed evidence on their efficacy. Incorporating these results into our current knowledge provides a basis on which to construct an evidence-based guide on how best to manage patients who suffer from FBSS. Wiley Periodicals, Inc.

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The burden of neuropathic pain: a systematic review and meta-analysis of health utilities.

Alissa H. Doth, Susan S. Taylor, T Hansson … (2010)

Patients with neuropathic pain (NeuP) experience substantially lower health-related quality of life (HRQoL) than the general population. The aim of this systematic review and meta-analysis is to test the hypothesis that NeuP is associated with low levels of health utility. A structured search of electronic databases (MEDLINE, EMBASE, Cochrane Library and CINAHL) was undertaken. Reference lists of retrieved reports were also reviewed. Studies reporting utility single-index measures (preference based) in NeuP were included. Random effects meta-analysis was used to pool EQ-5D index utility estimates across NeuP conditions. The association of utilities and pre-defined factors (NeuP condition, patient age, sex, duration and severity of pain and method of utility scoring) was examined using meta-regression. Twenty-four studies reporting health utility values in patients with NeuP were included in the review. Weighted pooled utility score across the studies varied from a mean of 0.15 for failed back surgery syndrome to 0.61 for post-herpetic neuralgia and diabetic neuropathy. Although there was substantial heterogeneity (P<0.0001) across studies, we found little variation in utility as a function of patient and study characteristics. The single exception was a significant relationship (P<0.0001) between increasing neuropathic pain severity and a reduction in utility. This study confirms the hypothesis that patients with NeuP experience low utilities and therefore low HRQoL. However, the contribution of non-NeuP co-morbidity remains unclear. Neuropathic pain severity emerged as a primary predictor of the negative health impact of NeuP. Copyright 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2017

Publication date (Electronic): 11 September 2017

Volume: 7

Issue: 9

Electronic Location Identifier: e017585

Affiliations

[1 ]PHMR, Ltd , London, UK

[2 ]departmentCentre for Addiction and Mental Health , Institute for Mental Health Policy Research , Toronto, Canada

[3 ]departmentClinical Research Center , Boston Children’s Hospital, Harvard Medical School , Boston, USA

[4 ]National Centre for Pharmacoeconomics , Dublin, UK

[5 ]departmentDepartment of Medicine , Imperial College , London, UK

[6 ]departmentTrauma and Orthopaedics Department , Ipswich Hospital , Ipswich, UK

[7 ]departmentWarwick Clinical Trials Unit , Warwick Medical School, University of Warwick , Coventry, UK

[8 ]departmentCentre for Health Economics , York University , York, UK

[9 ]departmentInstitute of Health Services Research , University of Exeter Medical School , Exeter, UK

[10 ]departmentDepartment of Pain and Anesthesia , The James Cook University Hospital , Middlesbrough, UK

Author notes

[Correspondence to ] Dr Sharada Weir; sharadaweir@ 123456phmr.com , sharadaweir@ 123456gmail.com

Author information

Sharada Weir http://orcid.org/0000-0002-3206-6034

Julie Bruce http://orcid.org/0000-0002-8462-7999

Article

Publisher ID: bmjopen-2017-017585

DOI: 10.1136/bmjopen-2017-017585

PMC ID: 5595197

PubMed ID: 28893756

SO-VID: 2ddc7719-4fce-4efc-b9d2-d105ae8347ff

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

History

Date received : 02 May 2017

Date revision received : 24 July 2017

Date accepted : 31 July 2017

Funding

Funded by: Medtronic International Trading Sàrl, Switzerland;

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special-feature unlocked

ScienceOpen disciplines: Medicine

Keywords: persistent post-operative pain (ppp),failed back surgery syndrome (fbss),lumbar surgery,clinical practice research datalink (cprd),hospital episode statistics (hes)

Data availability:

ScienceOpen disciplines: Medicine

Keywords: persistent post-operative pain (ppp), failed back surgery syndrome (fbss), lumbar surgery, clinical practice research datalink (cprd), hospital episode statistics (hes)

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)

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Abstract

Objective

Design

Setting

Participants

Primary and secondary outcomes measures

Results

Conclusions

Related collections

Orthopedics

Most cited references 25

Preoperative anxiety and catastrophizing: a systematic review and meta-analysis of the association with chronic postsurgical pain.

Failed back surgery syndrome.

The burden of neuropathic pain: a systematic review and meta-analysis of health utilities.

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