Incidence and treatment of complex regional pain syndrome after surgery: analysis of claims data from Germany

Abstract

Introduction: Complex regional pain syndrome (CRPS) is a rare complication after limb injuries. Early recognition of the symptomatology and interdisciplinary interventions are essential to prevent long-term disability and pain.

Objective: This article presents results on the incidence of CRPS after surgery in Germany and treatments used by patients with CRPS, using claims data from the BARMER, a German nationwide health care insurance.

Methods: A total of N = 85,862 BARMER patients with inpatient surgery on the upper or lower limb in 2018 were included. Patients with CRPS were identified by documented International Statistical Classification of Diseases and Related Health Problems -10 diagnosis within 12 months after surgery. For the same period, medication and nonpharmaceutical therapies for inpatient and outpatient care were assessed.

Results: The overall incidence of CRPS within 12 months after surgery was 0.34%. With 0.60%, the incidence of CRPS after surgeries of the upper limb was 3 times higher than after lower-limb surgeries (0.20%). Women were more frequently affected, and most patients were between 50 and 70 years old. About 80% to 90% of patients with CRPS received physiotherapy and nonopioid pain medication within 12 months after surgery. Approximately 40% to 50% were treated with opioids and/or antineuropathic medication. Cortisone, bisphosphonates, pain therapy, and occupational therapy were rarely claimed.

Conclusion: We found a low incidence of CRPS after various types of surgeries. Although previous research has focused on distal radius fractures and ankle surgery, our data suggest that clinicians should be aware of CRPS after other types of surgeries as well. Real-world treatment of CRPS does not reflect recommendations in clinical practice guidelines.

Keywords: Claims data; Complex regional pain syndrome; Health services research; Incidence; Pain therapy.