A Nationwide Sample Cohort Study With a 10-year Follow-up
Kim, Chi Heon MD, PhD∗,†; Chung, Chun Kee MD, PhD∗,†,‡; Choi, Yunhee PhD§; Kim, Min-Jung MS§; Yim, Dahae MS§; Yang, Seung Heon MD∗,†; Lee, Chang Hyun MD∗,†; Jung, Jong-Myung MD¶; Hwang, Sung Hwan MD∗,†; Kim, Dong Hwan MD∗,†; Yoon, Joon Ho MD∗,†; Park, Sung Bae MD, PhD∗,†,||
Spine: October 1, 2019 – Volume 44 – Issue 19 – p 1382-1389
doi: 10.1097/BRS.0000000000003065
HEALTH SERVICES RESEARCH
Study Design. A retrospective cohort study of a nationwide sample database.
Objective. The objective of the present study was to compare the long-term incidence of reoperation for lumbar herniated intervertebral disc disease (HIVD) after major surgical techniques (open discectomy, OD; laminectomy; percutaneous endoscopic lumbar discectomy, PELD; fusion).
Summary of Background Data. HIVD is a major spinal affliction; if the disease is intractable, surgery is recommended. Considering both the aging of patients and the chronicity of lumbar degenerative disease, the effect of surgical treatment for the lumbar spine should be durable for as long as possible.
Methods. The National Health Insurance Service-National Sample Cohort (NHIS-NSC) of Republic of Korea was utilized to establish a cohort of adult patients (N = 1856) who underwent first surgery for lumbar HIVD during 2005 to 2007. Patients were followed for 8 to 10 years. Considering death before reoperation as a competing event, reoperation hazards were compared among surgical techniques using the Fine and Gray regression model after adjustment for age, gender, Charlson comorbidity score, osteoporosis, diabetes, the severity of disability, insurance type, and hospital type.
Results. The overall cumulative incidences of reoperation were 4% at 1 year, 6% at 2 years, 8% at 3 years, 11% at 5 years, and 16% at 10 years. The cumulative incidences of reoperation were 16%, 14%, 16%, and 10% after OD, laminectomy, PELD, and fusion, respectively, at 10 years postoperation, with no difference among the surgical techniques. However, the distribution of reoperation types was significantly different according to the first surgical technique (P < 0.01). OD was selected as the reoperation surgical technique in 80% of patients after OD and in 81% of patients after PELD.
Conclusion. The probability of reoperation did not differ among OD, laminectomy, PELD, and fusion during the 10-year follow-up period. However, OD was the most commonly used technique in reoperation.
Level of Evidence: 4