Abstract
PurposeTo compare rates of persistent postoperative pain (PPP) after lumbar spine surgery—commonly known as Failed Back Surgery Syndrome—and healthcare costs for instrumented lumbar spinal fusion versus decompression/discectomy.MethodsThe UK population-based healthcare data from the Hospital Episode Statistics (HES) database from NHS Digital and the Clinical Practice Research Datalink (CPRD) were queried to identify patients with PPP following lumbar spinal surgery. Rates of PPP were calculated by type of surgery (instrumented and non-instrumented). Total healthcare costs associated with the surgery and covering the 24-month period after index hospital discharge were estimated using standard methods for classifying health care encounters into major categories of health care resource utilization (i.e., inpatient hospital stays, outpatient clinic visits, accident and emergency attendances, primary care encounters, and medications prescribed in primary care) and applying the appropriate unit costs (expressed in 2013 GBP).ResultsIncreasing the complexity of surgery with instrumentation was not associated with an increased rate of PPP. However, 2-year healthcare costs following discharge after surgery are significantly higher among patients who underwent instrumented surgery compared with decompression/discectomy.ConclusionsAlthough there is a not insubstantial risk of ongoing pain following spine surgery, with 1-in-5 patients experiencing PPP within 2 years of surgery, the underlying indications for surgical modality and related choice of surgical procedure do not, by itself, appear to be a driving factor.
Highlights
The rate of spinal surgery in the United Kingdom (UK) has risen dramatically over recent years [1]
We aim to address the following research questions: Are instrumented lumbar spinal fusion patients more likely to experience postoperative pain (PPP) up to 2 years following surgery compared to those undergoing non-instrumented lumbar spine surgery? Are healthcare costs higher in patients who undergo instrumented surgery compared to non-instrumented surgery, in the 2 years following surgery? The first question concerns one of the key contemporary controversies in lumbar spine surgery
We estimated total healthcare costs over the 24 month period after index hospital discharge by classifying health care encounters into major categories of health care resource utilization
Summary
The rate of spinal surgery in the UK has risen dramatically over recent years [1]. A large proportion of patients undergo instrumentation of their spine as part of their primary procedure. Prior research has highlighted a low, but clinically relevant, increased complication rate after lumbar spinal surgery with the introduction of pedicle screws [4], but no previous studies have compared the rates of PPP in patients undergoing instrumented vs non-instrumented spinal surgery. We aim to address the following research questions: Are instrumented lumbar spinal fusion patients more likely to experience PPP up to 2 years following surgery compared to those undergoing non-instrumented lumbar spine surgery? Are healthcare costs higher in patients who undergo instrumented surgery compared to non-instrumented surgery, in the 2 years following surgery?
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