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Eur Spine J. 2019 Jan 30. doi: 10.1007/s00586-018-05871-5. [Epub ahead of print]

Reoperation following lumbar spinal surgery: costs and outcomes in a UK population cohort study using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES).

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PHMR, Ltd., Bldg D, Berkeley Works, Berkley Grove, London, NW1 8XY, UK.
PHMR, Ltd., Bldg D, Berkeley Works, Berkley Grove, London, NW1 8XY, UK.
Harvard Medical School, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
Centre for Neuroinflammation and Neurodegeneration, Division of Brain Sciences, Department of Medicine, Imperial College, Du Cane Road, London, W120NN, UK.
Centre for Health Economics, Alcuin A, University of York, York, YO10 5DD, UK.
Institute of Health Research, University of Exeter Medical School, South Cloisters, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK.
Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
Department of Pain Medicine, Cheriton House, The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3 BW, UK.
Trauma and Orthopaedics Department, Ipswich Hospital, Heath Road, Ipswich, Suffolk, IP4 5PD, UK.



To assess the likelihood of persistent postoperative pain (PPP) following reoperation after lumbar surgery and to estimate associated healthcare costs.


This is a retrospective cohort study using two linked UK databases: Hospital Episode Statistics and UK Clinical Practice Research Datalink. Costs and outcomes associated with reoperation were evaluated over a 2-year postoperative period using multivariate logistic regression for cases who underwent reoperation and controls who did not, based on demographics, index surgery type, smoking status, and pre-index comorbidities using propensity score matching.


Risk factors associated with reoperation included younger age and the presence of diabetes with complications or rheumatic disease. The rate of PPP after reoperation was much higher than after index surgery, with 79 of 200 (39.5%; 95% CI 32.5%, 46.5%) participants experiencing ongoing pain compared with 983 of 5022 (19.5%; 95% CI 18.5%, 20.7%) after index surgery. Mean costs in the 2 years following reoperation were £1889 higher (95% CI £2, £3809) than for patients with PPP who did not undergo repeat surgery over an equivalent follow-up period. With the cost of reoperation itself included, the mean cost difference for patients who underwent reoperation compared with matched controls rose to £7221 (95% CI £5273, £9206).


High rates of PPP and associated healthcare costs suggest that returning to the operating room is a complex and challenging decision. Spinal surgeons should review whether the potential benefits of additional surgery are justified when other approaches to managing and relieving chronic pain have demonstrated superior outcomes. These slides can be retrieved under Electronic Supplementary Material.


Cost; Lumbar surgery; Persistent postoperative pain; Reoperation


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