173. The timing and incidence of surgical intervention following diagnosis of lumbar disc herniation at military treatment facilities

Abstract

BACKGROUND CONTEXT The clinical syndrome of radiculopathy from lumbar disc herniation (LDH) is a major cause of morbidity and cost among United States civilians and active duty service members. LDH is one of the most common diagnoses in spine practice with the incidence of incidence of symptomatic LDH in the United States estimated at 1% to 2%. PURPOSE The purposes of this study were to determine survival of conservative management of lumbar disc herniation in the military health system (MHS), and to determine risk factors to fail conservative management amongst MHS beneficiaries. STUDY DESIGN/SETTING After IRB approval we performed a retrospective observational review of Military Health System (MHS) beneficiaries. PATIENT SAMPLE The Military Heath System Data Repository (MDR) contains patient specific detail on all health care beneficiaries including active duty service members, dependents and retirees. In this set of patients, we then identified patients that failed conservative management, finding the time to the first post-diagnosis encounter for lumbar microdiscectomy or lumbar decompression. OUTCOME MEASURES Multivariable Cox proportional hazards models were used to evaluate the associations of patient and diagnosing facility characteristics with time to surgical intervention over the study period. METHODS The MDR was queried for all patients diagnosed with lumbar disc herniation from FY2011-2018; the earliest such diagnosis was kept for each patient as the initial diagnosis. Censoring was determined to be the first day of the last month each patient was eligible to receive MHS benefits. Patients were also queried for history of smoking status (yes/no) at any time during MHS care, age at the time of diagnosis, sex, MHS beneficiary category, and the skill/training of the diagnosing provider. RESULTS A total of 84,985 MHS beneficiaries including 62,771 active duty service members were diagnosed with LDH in a military treatment facility during the study period. 10,532 (12.4%) MHS beneficiaries, including 7,650 (10.9%) active duty service, failed conservative management onto surgical intervention with lumbar microdiscectomy or lumbar decompression. Multivariable Cox regression among all health care beneficiaries revealed that younger age, male sex, and history of smoking were each associated with higher risk of surgical intervention independent of diagnosing facility characteristics. CONCLUSIONS LDH compromises the readiness of our troops and negatively impacts healthcare costs for the Department of Defense (DoD). MHS beneficiaries with LDH have a good prognosis with approximately 88% of patients successfully completing conservative management. However, younger patients with a history of smoking should be educated that they are more likely to fail conservative management than patients without those demographic features. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.