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Reoperation Rate After Surgery for Lumbar Herniated Intervertebral Disc Disease: Nationwide Cohort Study

Kim, Chi Heon MD, PhD*,†,‡; Chung, Chun Kee MD, PhD*,†,‡; Park, Choon Seon PhD§; Choi, Boram PhD§; Kim, Min Jung MS; Park, Byung Joo MD, MPH, PhD¶,[BULLET OPERATOR]

Spine:
doi: 10.1097/BRS.0b013e318274f9a7
Health Services Research
SLIDE
Abstract

Study Design. Retrospective cohort study using national health insurance data.

Objective. To provide a longitudinal reoperation rate after surgery for lumbar herniated intervertebral disc (HIVD) disease, and to compare the reoperation rates of surgical methods.

Summary of Background Data. Herniated intervertebral disc disease is the most common cause of lumbar spinal surgery. Despite improved surgical techniques and instrumentation, reoperation cannot be avoided. The reoperation rates were in the range of 6% to 24% in previous studies. A population-based study is less subject to bias; hence, a nationwide longitudinal analysis was warranted.

Methods. A national health insurance database was used to identify a cohort of patients who underwent first surgery for herniated intervertebral disc disease in 2003 and 18,590 patients were selected. Individual patients were followed for at least 5 years through their encrypted unique resident registration number. The primary endpoint was any type of second lumbar surgery. After adjusting for confounding factors, 5 surgical methods (fusion, laminectomy, open discectomy, endoscopic discectomy, and nucleolysis [including mechanical nucleus decompression]) were compared. Open discectomy was used as the reference method.

Results. Open discectomy was the most common procedure (68.9%) followed by endoscopic discectomy (16.1%), laminectomy (7.9%), fusion (3.9%), and nucleolysis (3.2%). The cumulative reoperation rate was 5.4% at 3 months, 7.4% at 1 year, 9% at 2 years, 10.5% at 3 years, 12.1% at 4 years, and 13.4% at 5 years. The reoperation rates were 18.6%, 14.7%, 13.8%, 12.4%, and 11.8% after laminectomy, nucleolysis, open discectomy, endoscopic discectomy, and fusion, respectively. Compared with open discectomy, the reoperation rate was higher after laminectomy at 3 months, whereas the other surgical methods had similar rates.

Conclusion. The cumulative reoperation rate after 5 years was 13.4% and half of the reoperations occurred during the first postoperative year. With the exception of laminectomy, the reoperation rates of the other procedures were not different from that of open discectomy.

In Brief

A retrospective, population-based, cohort study using national health insurance database was performed. The reoperation rate after surgery for lumbar herniated intervertebral disc disease was 5.4% at 3 months, 7.4% at 1 year, and 13.4% at 5 years. Except for laminectomy, the reoperation rates of the other lumbar surgeries were not different from that of open discectomy.

Author Information

*Department of Neurosurgery, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea

Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, South Korea

Clinical Research Institute, Seoul National University Hospital, Seoul, Korea

§Health Insurance Review and Assessment Service

Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea; and

[BULLET OPERATOR]Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea

Address correspondence and reprint requests to Chun Kee Chung, MD, PhD, Department of Neurosurgery, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul, 110–744, South Korea; E-mail: chungc@snu.ac.kr

Acknowledgment date: March 14, 2012. First revision date: August 13, 2012. Acceptance date: September 14, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

National Research Foundation of Korea (NRF) grant funds were received to support this work (MEST) (2011–0000378).

No relevant financial activities outside the submitted work.

© 2013 Lippincott Williams & Wilkins, Inc.