Cervical surgery rate in neck pain patients with and without acupuncture treatment: a retrospective cohort study
https://doi.org/10.1136/acupmed-2018-011724
Article Information
Volume: 37 issue: 5, page(s): 268-276
Article first published online: August 20, 2019; Issue published: October 1, 2019
Dong-geun Han1, Wonil Koh1, Joon-Shik Shin1, Jinho Lee1, Yoon Jae Lee2, Me-riong Kim2, Kyungwon Kang2, Byung-Cheul Shin3, Jae-Heung Cho4, Nam-Kwen Kim5, In-Hyuk Ha2
1Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
2Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
3Spine and Joint Center, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
4Department of Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
5Monitoring Center for Korean Medicine and Western Medicine Collaboration, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
Corresponding Author:
In-Hyuk Ha, Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul 06110, Republic of Korea. Emails: hanihata@gmail.com
Abstract
Objective:
Surgical treatment of neck pain often entails high costs and adverse events. The present cohort study investigated whether utilization of acupuncture in neck pain patients is associated with a reduced rate of cervical surgery.
Methods:
The Korean National Health Insurance Service National Sample Cohort (NHIS-NSC) database was retrospectively analysed to identify the 2 year incidence of cervical surgery in Korean patients suffering neck pain from 2004 to 2010. The incidence was calculated and compared between patients receiving and not receiving acupuncture treatment using Cox proportional hazards models. Cumulative survival rates were compared using Kaplan-Meier survival analysis.
Results:
The acupuncture and control groups included 50 171 and 128 556 neck pain patients, respectively. A total of 50 161 patients were selected in each group following propensity score matching with regard to sex, age, income and Charlson comorbidity index. The hazard ratio (HR) for surgery within 2 years was significantly lower in the acupuncture group compared with the control group (HR 0.397, 95% CI 0.299 to 0.527). In addition, subgroup analyses according to gender, age and income revealed consistent results for both men (HR 0.337, 95% CI 0.234 to 0.485) and women (HR 0.529, 95% CI 0.334 to 0.836); the results were consistently observed across all age and income strata. Sensitivity analysis with varying numbers of acupuncture treatments and treatment course duration also consistently indicated lower HRs for surgery within 2 years in the acupuncture group compared with the control group.
Conclusions:
A significantly lower HR for cervical surgery was observed in neck pain patients following acupuncture treatment. Acupuncture treatment may therefore be an effective method for managing neck pain, and has the potential to mitigate unnecessary surgery. These findings need to be confirmed by prospective studies.