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