How to predict return to work after lumbar discectomy: answers from the NeuroPoint-SD registry

Than, Khoi D.; Curran, Jill; Resnick, Daniel K.; Shaffrey, Christopher I.; Ghogawala, Zoher; Mummaneni, Praveen V.

doi:10.3171/2015.10.spine15455

Cited by 23 publications

(23 citation statements)

References 15 publications

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“…In a holistic approach, we also assessed function through the patients’ occupation status, symptom they would most value treatment for, and NHS service use post-discharge. In patients of working age, we found 71% were able to return to full employment, roughly matching the data from previous studies regarding spinal surgery which found 67% patients were able to return to work over a 3-month to 5-year follow-up [25].…”

Section: Discussionsupporting

confidence: 89%

An assessment of patient-reported long-term outcomes following surgery for cauda equina syndrome

et al. 2019

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Background Data regarding long-term outcomes following surgery for cauda equina syndrome (CES) is scarce. In addition, these studies rely on patient descriptions of the presence or absence of symptoms, with no gradation of severity. This study aimed to assess long-term bladder, bowel, sexual and physical function using validated questionnaires in a CES cohort. Methods A pre-existing ethically approved database was used to identify patients who had undergone surgery for CES between August 2013 and November 2014. Patients were contacted over a 1-month period between August and September 2017 and completed validated questionnaires via telephone, assessing bladder (Urinary Symptom Profile), bowel (Neurogenic Bowel Dysfunction Score), sexual dysfunction (Arizona Sexual Experiences Scale) and physical function (Physical Component Summary of SF-12 Questionnaire), with scores compared between those presenting with incomplete CES (CES-I) and CES with retention (CES-R). Patients were also asked which of their symptoms currently they would most value treatment for and what healthcare services they had accessed post-operatively. Results Forty-six of 77 patients (response rate 72%, inclusion rate 60%) with a mean age of 45 years (21–83) and mean time since admission of 43 months (range 36–60) took part in the follow-up study. The prevalence of bladder dysfunction was 76%, bowel dysfunction 13%, sexual dysfunction 39% and physical dysfunction 48%. Patients presenting with CES-R had significantly worse long-term outcomes in bladder (stream domain), bowel and sexual function in compared to those with CES-I. Pain was chosen as the symptom patients would most value treatment for by 57%, but only 7% reported post-operative pain management referral. Conclusions With a mean follow-up time of 43 months, these findings confirm the high prevalence of long-term bladder, sexual and physical dysfunction in CES patients and that a diagnosis of CES-R confers poorer outcomes. This study provides useful, objective data to guide the expectations of patients and clinicians.

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Section: Discussionsupporting

confidence: 89%

An assessment of patient-reported long-term outcomes following surgery for cauda equina syndrome

et al. 2019

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“…Older age (OR 0.92; 95% CI 0.85 to 0.99) predicted reduced RTW at 3 months 28. Passive pain coping (OR 1.08, SE 0.04, estimated 95% CI 1.00 to 1.1726 and higher physical work load (OR 1.19, SE 0.06, estimated 95% CI 1.06 to 1.34)26 predicted reduced RTW at 6 months.…”

Section: Resultsmentioning

confidence: 97%

“…The number of participants varied from 46 to 394 per cohort, mean age ranged from 35 to 46 years, 28%–78% were male and all analyses included working populations. Two cohorts measured short-term follow-up at 328 and 6 months 26. Long-term outcomes ranged from 2,22 25 3,27 423 to 10 years24 follow-up, with the majority measured between 2 and 4 years.…”

Section: Resultsmentioning

confidence: 99%

“…Depression (estimated OR 1.5422) and occupational mental stress (estimated OR 1.3222) predicted reduced RTW at 2 years. No association with RTW was found for sex (OR 0.22; 95% CI 0.04 to 1.09), BMI (OR 0.90; 95% CI 0.78 to 1.04), general health (OR 1.03; 95% CI 0.98 to 1.08) and physical function (OR 1.06; 95% CI 0.997 to 1.13), smoking status (OR 4.37; 95% CI 0.82 to 23.27)28; neither for a combined measure of pain and disability presurgery (estimated OR 1.4222), job satisfaction (OR 0.9826) and duration of sick leave (OR 1.2626). The latter two studies22 26 did not present CIs.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of prognostic factors for work participation in patients with sciatica

et al. 2019

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Sciatica impacts on the ability to work and may lead to a reduced return to work. This study reviewed and summarised prognostic factors of work participation in patients who received conservative or surgical treatment for clinically diagnosed sciatica. We searched MEDLINE, CINAHL, EMBASE and PsycINFO until January 2018. Cohort studies, using a measure of work participation as outcome, were included. Two independent reviewers performed study inclusion and used the Quality In Prognosis Studies tool for risk of bias assessment and GRADE to rate the quality of the evidence. Based on seven studies describing six cohorts (n=1408 patients) that assessed 21 potential prognostic factors, favourable factors for return to work (follow-up ranging from 3 months to 10 years) included younger age, better general health, less low back pain or sciatica bothersomeness, better physical function, negative straight leg raise-test, physician expecting surgery to be beneficial, better pain coping, less depression and mental stress, less fear of movement and low physical work load. Study results could not be pooled. Using GRADE, the quality of the evidence ranged from moderate to very low, with downgrading mainly for a high risk of bias and imprecision. Several prognostic factors like pain, disability and psychological factors were identified and reviewed, and these could be targeted using additional interventions to optimise return to work. PROSPERO registration number: CRD42016042497.

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“…5,6,12,24 This may be attributed to the fact that these represent a more driven subset of patients who have better social support, work satisfaction, healthier psychological state, availability of modified duty, optimum physical demand at work, and employer-employee relations including the availability of litigation issues. 4,5,12,26,31,34,40 Together, these factors may contribute to these patients having superior outcomes after spine surgery.…”

Section: Discussionmentioning

confidence: 99%

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

Mummaneni

Bydon

Alvi

et al. 2019

Neurosurgical Focus

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OBJECTIVESince the enactment of the Affordable Care Act in 2010, providers and hospitals have increasingly prioritized patient-centered outcomes such as patient satisfaction in an effort to adapt the “value”-based healthcare model. In the current study, the authors queried a prospectively maintained multiinstitutional spine registry to construct a predictive model for long-term patient satisfaction among patients undergoing surgery for Meyerding grade I lumbar spondylolisthesis.METHODSThe authors queried the Quality Outcomes Database for patients undergoing surgery for grade I lumbar spondylolisthesis between July 1, 2014, and June 30, 2016. The primary outcome of interest for the current study was patient satisfaction as measured by the North American Spine Surgery patient satisfaction index, which is measured on a scale of 1–4, with 1 indicating most satisfied and 4 indicating least satisfied. In order to identify predictors of higher satisfaction, the authors fitted a multivariable proportional odds logistic regression model for ≥ 2 years of patient satisfaction after adjusting for an array of clinical and patient-specific factors. The absolute importance of each covariate in the model was computed using an importance metric defined as Wald chi-square penalized by the predictor degrees of freedom.RESULTSA total of 502 patients, out of a cohort of 608 patients (82.5%) with grade I lumbar spondylolisthesis, undergoing either 1- or 2-level decompression (22.5%, n = 113) or 1-level decompression and fusion (77.5%, n = 389), met the inclusion criteria; of these, 82.1% (n = 412) were satisfied after 2 years. On univariate analysis, satisfied patients were more likely to be employed and working (41.7%, n = 172, vs 24.4%, n = 22; overall p = 0.001), more likely to present with predominant leg pain (23.1%, n = 95, vs 11.1%, n = 10; overall p = 0.02) but more likely to present with lower Numeric Rating Scale score for leg pain (median and IQR score: 7 [5–9] vs 8 [6–9]; p = 0.05). Multivariable proportional odds logistic regression revealed that older age (OR 1.57, 95% CI 1.09–2.76; p = 0.009), preoperative active employment (OR 2.06, 95% CI 1.27–3.67; p = 0.015), and fusion surgery (OR 2.3, 95% CI 1.30–4.06; p = 0.002) were the most important predictors of achieving satisfaction with surgical outcome.CONCLUSIONSCurrent findings from a large multiinstitutional study indicate that most patients undergoing surgery for grade I lumbar spondylolisthesis achieved long-term satisfaction. Moreover, the authors found that older age, preoperative active employment, and fusion surgery are associated with higher odds of achieving satisfaction.

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How to predict return to work after lumbar discectomy: answers from the NeuroPoint-SD registry

Cited by 23 publications

References 15 publications

An assessment of patient-reported long-term outcomes following surgery for cauda equina syndrome

An assessment of patient-reported long-term outcomes following surgery for cauda equina syndrome

Systematic review of prognostic factors for work participation in patients with sciatica

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

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