Cost-Utility Analysis Of Injecting A "Dexamethasone Ropivacaine" Mixture Subcutaneously In The Management of Traumatic Bone Surgeries of The Forefoot

Abstract

Objectives: To evaluate the trajectory of productivity loss in patients diagnosed with lumbar disc herniation or spinal stenosis before and after surgery. MethOds: Patients who underwent surgery for spinal stenosis or lumbar disc herniation during 2000-2012 were identified from the national spine surgery register "Swespine". Additional data were extracted from Swedish registries including the National Patient Register and the Social Security Agency register. Productivity loss was measured as the sum of days with sick insurance benefits multiplied with the proportion of the patient's working time covered by a benefit. The main diagnosis registered at surgery was used in the analysis. Patients were followed for two years before and two years after surgery and were only included if in working age (19-64 years). Results: 18,315 patients who underwent surgery for lumbar disc herniation, and 11,511 patients who underwent surgery for spinal stenosis were identified for inclusion. In patients operated for disc herniation, productivity loss gradually increased during the year leading up to surgery, peaking at the first month post-surgery at almost full time work absence (25.3 days/month), and then gradually decreased. Mean days of productivity loss per month two years and year one before surgery was 5.2 and 9.4 days respectively, and 11.4 year one and 6.8 days year two post-surgery. Patients operated for spinal stenosis had a similar trajectory in productivity loss in relation to surgery, with a peak at the first month post-op (27.5 days/month). In this group, mean productivity loss/month was 12.0 year two and 15.4 year one pre-op, and 17.3 year one and 12.5 year two post-surgery. cOnclusiOns: Productivity loss after lumbar surgery returned to a level similar to the level two years before surgery. The trajectory was similar across the diagnosis groups, although the loss in spinal stenosis patients was higher over the four year time period.