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Reoperation following lumbar spinal surgery: costs and outcomes in a UK population cohort study using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES)

  • Sharada WeirEmail author
  • Tzu-Chun Kuo
  • Mihail Samnaliev
  • Travis S. Tierney
  • Andrea Manca
  • Rod S. Taylor
  • Julie Bruce
  • Sam Eldabe
  • David Cumming
Original Article

Abstract

Purpose

To assess the likelihood of persistent postoperative pain (PPP) following reoperation after lumbar surgery and to estimate associated healthcare costs.

Methods

This is a retrospective cohort study using two linked UK databases: Hospital Episode Statistics and UK Clinical Practice Research Datalink. Costs and outcomes associated with reoperation were evaluated over a 2-year postoperative period using multivariate logistic regression for cases who underwent reoperation and controls who did not, based on demographics, index surgery type, smoking status, and pre-index comorbidities using propensity score matching.

Results

Risk factors associated with reoperation included younger age and the presence of diabetes with complications or rheumatic disease. The rate of PPP after reoperation was much higher than after index surgery, with 79 of 200 (39.5%; 95% CI 32.5%, 46.5%) participants experiencing ongoing pain compared with 983 of 5022 (19.5%; 95% CI 18.5%, 20.7%) after index surgery. Mean costs in the 2 years following reoperation were £1889 higher (95% CI £2, £3809) than for patients with PPP who did not undergo repeat surgery over an equivalent follow-up period. With the cost of reoperation itself included, the mean cost difference for patients who underwent reoperation compared with matched controls rose to £7221 (95% CI £5273, £9206).

Conclusions

High rates of PPP and associated healthcare costs suggest that returning to the operating room is a complex and challenging decision. Spinal surgeons should review whether the potential benefits of additional surgery are justified when other approaches to managing and relieving chronic pain have demonstrated superior outcomes.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Lumbar surgery Reoperation Persistent postoperative pain Cost 

Notes

Acknowledgements

This study was supported by Medtronic International Trading Sàrl, Switzerland and was based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. However, the interpretation and conclusions contained in this study are those of the authors alone.

Author’s contribution

DC conceived the study. SW acquired the data. TCK, MS, and SW developed the analysis plan. TCK and MS analysed the data. SW and DC drafted the manuscript. JB, DC, SE, TCK, AM, MS, RST, TT and SW revised the manuscript. All authors contributed intellectually to the interpretation of the data, participated in manuscript development and approved the final version. SW is the guarantor.

Funding

This study was supported by Medtronic International Trading Sàrl, Switzerland. However, Medtronic did not play a direct role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the manuscript for publication.

Compliance with ethical standards

Competing interests

PHMR, LLC, received consulting fees from Medtronic. SW, MS and TCK received consulting fees from PHMR, LLC. RST, AM, JB, DC and SE received consulting fees from Medtronic as advisors to the project. TT has no competing interests associated with this work.

Supplementary material

586_2018_5871_MOESM1_ESM.pptx (133 kb)
Supplementary material 1 (PPTX 133 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.PHMR, Ltd.LondonUK
  2. 2.Harvard Medical SchoolBoston Children’s HospitalBostonUSA
  3. 3.Centre for Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Department of MedicineImperial CollegeLondonUK
  4. 4.Centre for Health Economics, Alcuin AUniversity of YorkYorkUK
  5. 5.Institute of Health ResearchUniversity of Exeter Medical School, South Cloisters, St Lukes CampusExeterUK
  6. 6.Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical SchoolUniversity of WarwickCoventryUK
  7. 7.Department of Pain Medicine, Cheriton HouseThe James Cook University HospitalMiddlesbroughUK
  8. 8.Trauma and Orthopaedics DepartmentIpswich HospitalIpswichUK

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