Weir Sharada, Samnaliev Mihail, Kuo Tzu-Chun, Ni Choitir Caitriona, Tierney Travis S, Cumming David, Bruce Julie, Manca Andrea, Taylor Rod S, Eldabe Sam
PHMR, Ltd, London, UK.
Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada.
BMJ Open. 2017 Sep 11;7(9):e017585. doi: 10.1136/bmjopen-2017-017585.
To characterise incidence and healthcare costs associated with persistent postoperative pain (PPP) following lumbar surgery.
Retrospective, population-based cohort study.
Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases.
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.
Incidence and total healthcare costs over 2, 5 and 10 years attributable to persistent PPP following initial lumbar surgery.
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 £5383 (95% CI £4872 to £5916). Over 5 and 10 years following initial spine surgery, the mean cost difference between patients with and without PPP increased to £10 195 (95% CI £8726 to £11 669) and £14 318 (95% CI £8386 to £19 771), 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 £70 million over the first 10 years alone.
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.
描述腰椎手术后持续性术后疼痛（PPP）的发生率及医疗费用。
基于人群的回顾性队列研究。
临床实践研究数据链（CPRD）和医院事件统计（HES）数据库。
1997/1998年至2011/2012年在英格兰接受腰椎手术的10216名成年人组成的基于人群的队列，且在CPRD-HES链接数据中有至少1年的术前数据和2年的术后随访数据。
初次腰椎手术后2年、5年和10年因持续性PPP导致的发生率及总医疗费用。
在1997/1998财年至2011/2012年的15年研究期间，CPRD-HES链接数据中接受腰椎手术的个体比例翻倍，从每10000名成年人中的2.5例增至4.9例。在最近的5年期间（2007/2008年至2011/2012年），平均20.8%（95%CI 19.7%至21.9%）的腰椎手术患者符合PPP标准。所有类型护理中，PPP患者的医疗使用频率显著更高。初次脊柱手术后2年，有PPP和无PPP患者的平均费用差异为5383英镑（95%CI 4872英镑至5916英镑）。初次脊柱手术后5年和10年，有PPP和无PPP患者的平均费用差异分别增至10195英镑（95%CI 8726英镑至11669英镑）和14318英镑（95%CI 8386英镑至19771英镑）。推算至英国人群，我们估计每年近5000名成年人脊柱手术后会经历PPP，仅在前10年，每个新队列就让英国国民医疗服务体系花费超过7000万英镑。
持续性疼痛影响超过五分之一的腰椎手术患者，并导致大量长期医疗费用。需要制定正式的、基于证据的指南，以制定针对腰椎手术后持续疼痛患者的连贯、协调管理策略。
