An analysis from the Quality Outcomes Database, Part 2. Predictive model for return to work after elective surgery for lumbar degenerative disease

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Current costs associated with spine care are unsustainable. Productivity loss and time away from work for patients who were once gainfully employed contributes greatly to the financial burden experienced by individuals and, more broadly, society. Therefore, it is vital to identify the factors associated with return to work (RTW) after lumbar spine surgery. In this analysis, the authors used data from a national prospective outcomes registry to create a predictive model of patients’ ability to RTW after undergoing lumbar spine surgery for degenerative spine disease.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Data from 4694 patients who underwent elective spine surgery for degenerative lumbar disease, who had been employed preoperatively, and who had completed a 3-month follow-up evaluation, were entered into a prospective, multicenter registry. Patient-reported outcomes—Oswestry Disability Index (ODI), numeric rating scale (NRS) for back pain (BP) and leg pain (LP), and EQ-5D scores—were recorded at baseline and at 3 months postoperatively. The time to RTW was defined as the period between operation and date of returning to work. A multivariable Cox proportional hazards regression model, including an array of preoperative factors, was fitted for RTW. The model performance was measured using the concordance index (c-index).</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Eighty-two percent of patients (n = 3855) returned to work within 3 months postoperatively. The risk-adjusted predictors of a lower likelihood of RTW were being preoperatively employed but not working at the time of presentation, manual labor as an occupation, worker’s compensation, liability insurance for disability, higher preoperative ODI score, higher preoperative NRS-BP score, and demographic factors such as female sex, African American race, history of diabetes, and higher American Society of Anesthesiologists score. The likelihood of a RTW within 3 months was higher in patients with higher education level than in those with less than high school–level education. The c-index of the model’s performance was 0.71.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>This study presents a novel predictive model for the probability of returning to work after lumbar spine surgery. Spine care providers can use this model to educate patients and encourage them in shared decision-making regarding the RTW outcome. This evidence-based decision support will result in better communication between patients and clinicians and improve postoperative recovery expectations, which will ultimately increase the likelihood of a positive RTW trajectory.</jats:p></jats:sec>

Predictors of patient dissatisfaction at 1 and 2 years after lumbar surgery

“…29 Extrapolating these data to spine surgery, lower-education patients may be constitutionally ill-equipped to overcome the morbidity associated with a lumbar procedure and rigorous postoperative rehabilitation. 4,29,41 This highlights a potential healthcare disparity in patients with lower levels of education. Whether this result reflects consequences unique to certain socioeconomic factors linked to education (or the lack thereof in this instance) or an increased comorbidity burden in this population warrants further investigation as well.…”

A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis

“…Patients who are employed preoperatively may reflect a subset of patients with greater social support, job satisfaction, job security and income, and adaptive psychological states. 2,3,9,17 These factors may accelerate recovery and participation in physical therapy and thus improve back pain and satisfaction. Likewise, patients with more labor-intensive occupations may not be able to abide by appropriate postoperative restrictions and may exacerbate their pain following surgery.…”

A predictive model and nomogram for predicting return to work at 3 months after cervical spine surgery: an analysis from the Quality Outcomes Database

“…Asher et al analyzed 4695 patients undergoing elective lumbar surgery for degenerative lumbar disease and found that work-related factors accounted for 33.3% of predictability of a patient returning to work postoperatively. 2 In our analysis, the most important predictor of return to work was the employment status preoperatively (i.e., currently working vs not working). A study by Anderson et al revealed that patients who were working at the time of surgery were 10 times more likely to return to work after a lumbar fusion, 1 showing that time away from work at the time of presentation is in itself a strong predictor of the patient not returning to work postoperatively.…”

“…This method has been described and previously used in other analyses from the QOD and allows the validation of the model without having to use an external data set. 2,15 We also tested the absolute importance of each variable that was included in the model on predicting 3-month return to work by using an importance metric defined as Wald chi-square penalized by the predictor degrees of freedom (i.e., Wald chi-squaredf). 16 We used multiple imputations from the rms package to impute missing values; this method used a combination of bootstrapping, additive regression, and predictive mean matching.…”