アブストラクト | 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 pound5383 (95% CI pound4872 to pound5916). Over 5 and 10 years following initial spine surgery, the mean cost difference between patients with and without PPP increased to pound10 195 (95% CI pound8726 to pound11 669) and pound14 318 (95% CI pound8386 to pound19 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 pound70 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. |
投稿者 | Weir, Sharada; Samnaliev, Mihail; Kuo, Tzu-Chun; Ni Choitir, Caitriona; Tierney, Travis S; Cumming, David; Bruce, Julie; Manca, Andrea; Taylor, Rod S; Eldabe, Sam |
組織名 | PHMR, Ltd, London, UK.;Centre for Addiction and Mental Health, Institute for Mental Health Policy;Research, Toronto, Canada.;Clinical Research Center, Boston Children's Hospital, Harvard Medical School,;Boston, USA.;National Centre for Pharmacoeconomics, Dublin, UK.;Department of Medicine, Imperial College, London, UK.;Trauma and Orthopaedics Department, Ipswich Hospital, Ipswich, UK.;Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick,;Coventry, UK.;Centre for Health Economics, York University, York, UK.;Institute of Health Services Research, University of Exeter Medical School,;Exeter, UK.;Department of Pain and Anesthesia, The James Cook University Hospital,;Middlesbrough, UK. |