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The incidence and healthcare costs of persistent postoperative pain following lumbar spine surgery in the UK: a cohort study using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES)
  1. Sharada Weir1,2,
  2. Mihail Samnaliev1,3,
  3. Tzu-Chun Kuo1,
  4. Caitriona Ni Choitir4,
  5. Travis S Tierney5,
  6. David Cumming6,
  7. Julie Bruce7,
  8. Andrea Manca8,
  9. Rod S Taylor9,
  10. Sam Eldabe10
  1. 1PHMR, Ltd, London, UK
  2. 2Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
  3. 3Clinical Research Center, Boston Children’s Hospital, Harvard Medical School, Boston, USA
  4. 4National Centre for Pharmacoeconomics, Dublin, UK
  5. 5Department of Medicine, Imperial College, London, UK
  6. 6Trauma and Orthopaedics Department, Ipswich Hospital, Ipswich, UK
  7. 7Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
  8. 8Centre for Health Economics, York University, York, UK
  9. 9Institute of Health Services Research, University of Exeter Medical School, Exeter, UK
  10. 10Department of Pain and Anesthesia, The James Cook University Hospital, Middlesbrough, UK
  1. Correspondence to Dr Sharada Weir; sharadaweir{at}, sharadaweir{at}


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 £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.

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.

  • Persistent post-operative pain (PPP)
  • Failed Back Surgery Syndrome (FBSS)
  • lumbar surgery
  • clinical practice research datalink (cprd)
  • hospital episode statistics (hes)

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  • Contributors SE, AM, RT and SW conceived and designed the study originally. JB and DC joined the study team part way through the analysis planning phase and helped to shape the final study design. SW acquired the data. CNC, T-CK, MS, TST and SW developed the analysis plan. T-CK, MS and SW analysed the data. SW drafted the manuscript. JB, DC, SE, T-CK, AM, MS, RT, TST 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.

  • Funding This study was supported by Medtronic International Trading Sàrl, Switzerland.

  • Disclaimer This study was based in part on data from the Clinical Practice Research Datalink obtained under license from the UK Medicines and Healthcare products Regulatory Agency. However, the interpretation and conclusions contained in this study are those of the authors alone.

  • Competing interests At the time of the study, CNC was employed by PHMR, LLC, who received consulting fees from Medtronic. SW, MS and T-CK received consulting fees from PHMR, LLC. RT, AM, JB, DC and SE received consulting fees from Medtronic as advisors to the project.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Independent Scientific Advisory Committee for Medicines and Healthcare products Regulatory Agency (MHRA)

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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