scholarly journals Persistent postoperative pain and healthcare costs associated with instrumented and non-instrumented spinal surgery: a case-control study

2019 ◽  
Author(s):  
Sharada Weir ◽  
Mihail Samnaliev ◽  
Tzu-Chun Kuo ◽  
Travis S. Tierney ◽  
Andrea Manca ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Postoperative Pain ◽  
Spine Surgery ◽  
Spinal Surgery ◽  
Healthcare Costs ◽  
Lumbar Spine Surgery ◽  
Failed Back Surgery ◽  
Persistent Postoperative Pain ◽  
Lumbar Spinal

Abstract Purpose. To 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. Methods. 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). Results. Increasing 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. Conclusions. Although there is a not insubstantial risk of ongoing pain following spine surgery, with 1-in-5 patients experiencing PPP within two years of surgery, the choice of surgical procedure does not, by itself, appear to be a driving factor.

scholarly journals Persistent postoperative pain and healthcare costs associated with instrumented and non-instrumented spinal surgery: a case-control study

2020 ◽  
Author(s):  
Sharada Weir ◽  
Mihail Samnaliev ◽  
Tzu-Chun Kuo ◽  
Travis S. Tierney ◽  
Andrea Manca ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Postoperative Pain ◽  
Spine Surgery ◽  
Spinal Surgery ◽  
Healthcare Costs ◽  
Lumbar Spine Surgery ◽  
Failed Back Surgery ◽  
Persistent Postoperative Pain ◽  
Lumbar Spinal

Abstract Purpose. To 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. Methods. 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). Results. Increasing 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. Conclusions. Although there is a not insubstantial risk of ongoing pain following spine surgery, with 1-in-5 patients experiencing PPP within two years of surgery, the choice of surgical procedure does not, by itself, appear to be a driving factor.

“A COMPARATIVE STUDY TO EVALUATE THE EFFICACY OF DULOXETINE IN POSTOPERATIVE PAIN RELIEF IN PATIENTS IN UNDERGOING LUMBAR SPINE SURGERY ”

2021 ◽  
pp. 76-77
Author(s):  
Deepti Chauhan ◽  
Satyendra Yadav ◽  
Heena Sheikh ◽  
Ashish Mathur
Keyword(s):  
Lumbar Spine ◽  
Postoperative Pain ◽  
Pain Relief ◽  
General Anaesthesia ◽  
Spine Surgery ◽  
Postoperative Pain Relief ◽  
Lumbar Spine Surgery ◽  
Analgesic Requirement ◽  
Respiratory Parameters ◽  
Result Analysis

AIMS AND OBJECTIVES: To evaluate the efcacy of duloxetine in different doses in postoperative pain relief in patients undergoing lumbar spine surgery. MATERIALAND METHOD: 80 patients of ASA grade І & ІІ of either sex scheduled for lumbar spine surgery under general anaesthesia were divided into 2 groups (n=40 each) randomly.Group D (n=40) Patients who received a 60 mg duloxetine 1 hour before surgery and another tablet the following morning. Group 'P'(n=40) Patients who received a placebo tablet 1 hour before surgery and again the following morning. Pulse rate, blood pressure, respiratory rate and severity of pain on NRS scale was noted at 0 hr, 4 hr, 8 hr, 12 hr, 16 hr, 20 hr, 24 hr, 28 hr, 32 hr and 48 hr after surgery. And the presence or absence of adverse effects, such as headache, nausea, vomiting, dizziness, and drowsiness were noted. RESULT: Analysis revealed that time for rst analgesic requirement was signicantly longer with oral Duloxetine 60 mg than with placebo. Pre-emptive oral Duloxetine 60 mg decreases the severity of pain postoperatively but not signicantly as compared to placebo in patients posted for lumbar spine surgery under general anaesthesia. Oral Duloxetine 60 mg had no signicant effect on cardiovascular and respiratory parameters. Patients receiving duloxetine had higher incidence of nausea, vomiting. CONCLUSION:that time for rst analgesic requirement was signicantly longer with oral Duloxetine 60 mg than placebo.

Gabapentin and Pregabalin in the Management of Postoperative Pain After Lumbar Spinal Surgery

Spine ◽  
2013 ◽  
Vol 38 (22) ◽  
pp. 1947-1952 ◽  
Author(s):  
Lin Yu ◽  
Bo Ran ◽  
Min Li ◽  
Zhicai Shi
Keyword(s):  
Postoperative Pain ◽  
Spinal Surgery ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal

scholarly journals Patient-reported outcomes 3 months after spine surgery: is it an accurate predictor of 12-month outcome in real-world registry platforms?

2015 ◽  
Vol 39 (6) ◽  
pp. E17 ◽  
Author(s):  
Scott L. Parker ◽  
Anthony L. Asher ◽  
Saniya S. Godil ◽  
Clinton J. Devin ◽  
Matthew J. McGirt
Keyword(s):  
Health Care ◽  
Spine Surgery ◽  
Real World ◽  
Patient Reported Outcomes ◽  
Lumbar Spine Surgery ◽  
Meaningful Improvement ◽  
Patient Level ◽  
Life Years ◽  
Patient Reported ◽  
Prospective Longitudinal

OBJECT The health care landscape is rapidly shifting to incentivize quality of care rather than quantity of care. Quality and outcomes registry platforms lie at the center of all emerging evidence-driven reform models and will be used to inform decision makers in health care delivery. Obtaining real-world registry outcomes data from patients 12 months after spine surgery remains a challenge. The authors set out to determine whether 3-month patient-reported outcomes accurately predict 12-month outcomes and, hence, whether 3-month measurement systems suffice to identify effective versus noneffective spine care. METHODS All patients undergoing lumbar spine surgery for degenerative disease at a single medical institution over a 2-year period were enrolled in a prospective longitudinal registry. Patient-reported outcome instruments (numeric rating scale [NRS], Oswestry Disability Index [ODI], 12-Item Short Form Health Survey [SF-12], EQ-5D, and the Zung Self-Rating Depression Scale) were recorded prospectively at baseline and at 3 months and 12 months after surgery. Linear regression was performed to determine the independent association of 3- and 12-month outcome. Receiver operating characteristic (ROC) curve analysis was performed to determine whether improvement in general health state (EQ-5D) and disability (ODI) at 3 months accurately predicted improvement and achievement of minimum clinical important difference (MCID) at 12 months. RESULTS A total of 593 patients undergoing elective lumbar surgery were included in the study. There was a significant correlation between 3-month and 12-month EQ-5D (r = 0.71; p < 0.0001) and ODI (r = 0.70; p < 0.0001); however, the authors observed a sizable discrepancy in achievement of a clinically significant improvement (MCID) threshold at 3 versus 12 months on an individual patient level. For postoperative disability (ODI), 11.5% of patients who achieved an MCID threshold at 3 months dropped below this threshold at 12 months; 10.5% of patients who did not meet the MCID threshold at 3 months continued to improve and ultimately surpassed the MCID threshold at 12 months. For ODI, achieving MCID at 3 months accurately predicted 12-month MCID with only 62.6% specificity and 86.8% sensitivity. For postoperative health utility (EQ-5D), 8.5% of patients lost an MCID threshold improvement from 3 months to 12 months, while 4.0% gained the MCID threshold between 3 and 12 months postoperatively. For EQ-5D (quality-adjusted life years), achieving MCID at 3 months accurately predicted 12-month MCID with only 87.7% specificity and 87.2% sensitivity. CONCLUSIONS In a prospective registry, patient-reported measures of treatment effectiveness obtained at 3 months correlated with 12-month measures overall in aggregate, but did not reliably predict 12-month outcome at the patient level. Many patients who do not benefit from surgery by 3 months do so by 12 months, and, conversely, many patients reporting meaningful improvement by 3 months report loss of benefit at 12 months. Prospective longitudinal spine outcomes registries need to span at least 12 months to identify effective versus noneffective patient care.

scholarly journals Continuous Spinal Analgesia after Extensive Lumbar Spine Surgery

2009 ◽  
Vol 37 (3) ◽  
pp. 473-476
Author(s):  
A. Mckenzie ◽  
M. Sherwood
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Spinal Surgery ◽  
Dural Puncture ◽  
Lumbar Spine Surgery ◽  
Spinal Analgesia ◽  
Post Dural Puncture Headache ◽  
Drug Doses ◽  
Spinal Catheter

A 77-year-old male underwent L-1 to S-1 spine decompression and fusion from L-3 to S-1. A 25 G spinal catheter was placed intraoperatively and bupivacaine 1.25 mg/ml, fentanyl 2 μg/ml and morphine 3 μg/ml infused. The patient was pain-free for the duration of the infusion. Continuous spinal analgesia was effective after extensive spinal surgery. The risks of post-dural puncture headache, infection of wound and/or meninges and the optimum drug doses and combinations are yet to be quantified in this setting.

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