Inamullah Khan1, Mohamad Bydon2, Kristin R Archer3, Ahilan Sivaganesan4, Anthony M Asher5, Muhammad Ali Alvi2, Panagiotis Kerezoudis2, John J Knightly6, Kevin T Foley7, Erica F Bisson8, Christopher Shaffrey9, Anthony L Asher10, Dan M Spengler5, Clinton J Devin11. 1. Department of Orthopedic Surgery, Vanderbilt University School of Medicine, South Tower, Suite 4200, Nashville, TN, USA; Department of Neurological surgery, Vanderbilt University School of Medicine, South Tower, Suite 4200, Nashville, TN, USA. 2. Department of Neurological Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, USA. 3. Department of Orthopedic Surgery, Vanderbilt University School of Medicine, South Tower, Suite 4200, Nashville, TN, USA; Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, South Tower, Suite 4200, Nashville, TN, USA. 4. Department of Neurological surgery, Vanderbilt University School of Medicine, South Tower, Suite 4200, Nashville, TN, USA. 5. Department of Orthopedic Surgery, Vanderbilt University School of Medicine, South Tower, Suite 4200, Nashville, TN, USA. 6. Atlantic NeuroSurgical Specialists, Morristown, NJ, USA. 7. Department of Neurosurgery, University of Tennessee Health Sciences Center, Semmes-Murphey Neurologic & Spine Institute, Memphis, TN, USA. 8. Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA. 9. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA. 10. Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, NC, USA. 11. Department of Orthopedic Surgery, Vanderbilt University School of Medicine, South Tower, Suite 4200, Nashville, TN, USA; Department of Neurological surgery, Vanderbilt University School of Medicine, South Tower, Suite 4200, Nashville, TN, USA; Orthopedics of Steamboat Springs, Steamboat Springs, CO, USA. Electronic address: clintondevin@gmail.com.
Abstract
BACKGROUND CONTEXT: Low back pain has an immense impact on the US economy. A significant number of patients undergo surgical management in order to regain meaningful functionality in daily life and in the workplace. Return to work (RTW) is a key metric in surgical outcomes, as it has profound implications for both individual patients and the economy at large. PURPOSE: In this study, we investigated the factors associated with RTW in patients who achieved otherwise favorable outcomes after lumbar spine surgery. STUDY DESIGN/ SETTING: This study retrospectively analyzes prospectively collected data from the lumbar module of national spine registry, the Quality Outcomes Database (QOD). PATIENT SAMPLE: The lumbar module of QOD includes patients undergoing lumbar surgery for primary stenosis, disc herniation, spondylolisthesis (Grade I) and symptomatic mechanical disc collapse or revision surgery for recurrent same-level disc herniation, pseudarthrosis, and adjacent segment disease. Exclusion criteria included age under 18 years and diagnoses of infection, tumor, or trauma as the cause of lumbar-related pain. OUTCOME MEASURES: The outcome of interest for this study was the return to work 12-month after surgery. METHODS: The lumbar module of QOD was queried for patients who were employed at the time of surgery. Good outcomes were defined as patients who had no adverse events (readmissions/complications), had achieved 30% improvement in Oswestry disability index (ODI) and were satisfied (NASS satisfaction) at 3-month post-surgery. Distinct multivariable logistic regression models were fitted with 12-month RTW as outcome for a. overall population and b. the patients with good outcomes. The variables included in the models were age, gender, race, insurance type, education level, occupation type, currently working/on-leave status, workers' compensation, ambulatory status, smoking status, anxiety, depression, symptom duration, number of spinal levels, diabetes, motor deficit, and preoperative back-pain, leg-pain and ODI score. RESULTS: Of the total 12,435 patients, 10,604 (85.3%) had successful RTW at 1-year postsurgery. Among patients who achieved good surgical outcomes, 605 (7%) failed to RTW. For both the overall and subgroup analysis, older patients had lower odds of RTW. Females had lower odds of RTW compared with males and patients with higher back pain and baseline ODI had lower odds of RTW. Patients with longer duration of symptoms, more physically demanding occupations, worker's compensation claim and those who had short-term disability leave at the time of surgery had lower odds of RTW independent of their good surgical outcomes. CONCLUSIONS: This study identifies certain risk factors for failure to RTW independent of surgical outcomes. Most of these risk factors are occupational; hence, involving the patient's employer in treatment process and setting realistic expectations may help improve the patients' work-related functionality.
BACKGROUND CONTEXT: Low back pain has an immense impact on the US economy. A significant number of patients undergo surgical management in order to regain meaningful functionality in daily life and in the workplace. Return to work (RTW) is a key metric in surgical outcomes, as it has profound implications for both individual patients and the economy at large. PURPOSE: In this study, we investigated the factors associated with RTW in patients who achieved otherwise favorable outcomes after lumbar spine surgery. STUDY DESIGN/ SETTING: This study retrospectively analyzes prospectively collected data from the lumbar module of national spine registry, the Quality Outcomes Database (QOD). PATIENT SAMPLE: The lumbar module of QOD includes patients undergoing lumbar surgery for primary stenosis, disc herniation, spondylolisthesis (Grade I) and symptomatic mechanical disc collapse or revision surgery for recurrent same-level disc herniation, pseudarthrosis, and adjacent segment disease. Exclusion criteria included age under 18 years and diagnoses of infection, tumor, or trauma as the cause of lumbar-related pain. OUTCOME MEASURES: The outcome of interest for this study was the return to work 12-month after surgery. METHODS: The lumbar module of QOD was queried for patients who were employed at the time of surgery. Good outcomes were defined as patients who had no adverse events (readmissions/complications), had achieved 30% improvement in Oswestry disability index (ODI) and were satisfied (NASS satisfaction) at 3-month post-surgery. Distinct multivariable logistic regression models were fitted with 12-month RTW as outcome for a. overall population and b. the patients with good outcomes. The variables included in the models were age, gender, race, insurance type, education level, occupation type, currently working/on-leave status, workers' compensation, ambulatory status, smoking status, anxiety, depression, symptom duration, number of spinal levels, diabetes, motor deficit, and preoperative back-pain, leg-pain and ODI score. RESULTS: Of the total 12,435 patients, 10,604 (85.3%) had successful RTW at 1-year postsurgery. Among patients who achieved good surgical outcomes, 605 (7%) failed to RTW. For both the overall and subgroup analysis, older patients had lower odds of RTW. Females had lower odds of RTW compared with males and patients with higher back pain and baseline ODI had lower odds of RTW. Patients with longer duration of symptoms, more physically demanding occupations, worker's compensation claim and those who had short-term disability leave at the time of surgery had lower odds of RTW independent of their good surgical outcomes. CONCLUSIONS: This study identifies certain risk factors for failure to RTW independent of surgical outcomes. Most of these risk factors are occupational; hence, involving the patient's employer in treatment process and setting realistic expectations may help improve the patients' work-related functionality.
Authors: Brian J Neuman; Kevin Y Wang; Andrew B Harris; Micheal Raad; Richard A Hostin; Themisctocles S Protopsaltis; Christopher P Ames; Peter G Passias; Munish C Gupta; Eric O Klineberg; Robert Hart; Shay Bess; Khaled M Kebaish Journal: Spine Deform Date: 2022-10-11
Authors: Kai-Uwe Lewandrowski; Narendran Muraleedharan; Steven Allen Eddy; Vikram Sobti; Brian D Reece; Jorge Felipe Ramírez León; Sandeep Shah Journal: Int J Spine Surg Date: 2020-10-29
Authors: Alexander Romagna; Jefferson R Wilson; W Bradley Jacobs; Michael G Johnson; Christopher S Bailey; Sean Christie; Jerome Paquet; Andrew Nataraj; David W Cadotte; Neil Manson; Hamilton Hall; Kenneth C Thomas; Christoph Schwartz; Y Raja Rampersaud; Greg McIntosh; Charles G Fisher; Nicolas Dea Journal: Global Spine J Date: 2020-10-16
Authors: Raul Laasik; Petteri Lankinen; Mika Kivimäki; Marko H Neva; Ville Aalto; Tuula Oksanen; Jussi Vahtera; Keijo T Mäkelä Journal: Acta Orthop Date: 2021-07-16 Impact factor: 3.717