Return to Work After Diskogenic Fusion in Workers' Compensation Subjects

Abstract

Lumbar fusion for degenerative disk disease (DDD) is associated with variable clinical outcomes. Patients with workers' compensation claims often have worse fusion outcomes than the general population. Few studies have evaluated the risk factors for poor outcomes within this clinically distinct population. The goal of this study was to identify preoperative predictors of return to work status after fusion for DDD in a workers' compensation setting. The authors used International Classification of Diseases, Ninth Revision (ICD-9), diagnosis and Current Procedural Terminology (CPT) procedural codes to identify 1037 subjects from the Ohio Bureau of Workers' Compensation database who underwent fusion for DDD between 1993 and 2013. Of these subjects, 23.2% (n=241) made a sustained return to work within 2 years after fusion. To identify preoperative predictors of postoperative return to work status, the authors used multivariate logistic regression analysis, adjusting for many important covariates. These included prolonged time out of work (P<.001; odds ratio [OR], 0.24), psychiatric history (P<.001; OR, 0.14), prolonged use of opioid analgesics (P<.001; OR, 0.46), male sex (P=.014; OR, 0.65), and legal representation (P=.042; OR, 0.67). The return to work rates associated with these risk factors were 10.4%, 2.0%, 11.9%, 21.1%, and 20.7%, respectively. Of the study subjects, 76.8% (n=796) did not return to work and had considerably worse postoperative outcomes, highlighted by chronic opioid dependence and high rates of failed back syndrome, additional surgery, and new psychiatric comorbidity. The low return to work rates and other generally poor outcomes reported in this study may indicate a more limited role for lumbar fusion among patients with DDD who have workers' compensation claims. More studies are needed to determine whether fusion for DDD can improve function and quality of life in these patients.

Prognostic Variables for Patient Return-to-Work Interval Following Carpal Tunnel Release in a Workers’ Compensation Population

“…31 Although we were unable to identify any previous studies demonstrating preoperative opioid use predicting delayed RTW in patients undergoing CTR, a similarly designed recent study in patients undergoing lumbar fusion found preoperative opioid use to predict delayed postoperative RTW. 2 Furthermore, our multivariate model suggests that these conditions may have an additive, exponential effect on delaying RTW. Interestingly, patients who were either out of duty or on modified duty took twice as long to return back to work compared with patients who were on full-duty.…”

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

“…Previous studies have demonstrated similar associations between preoperative employment status and postoperative RTW. 2,4,34 Time away from work has a direct negative correlation with RTW. 28 Anderson et al have reported that patients who were working at the time of surgery were 10.5 times more likely to be working at follow-up after fusion surgery.…”

“…20,26,30 This disability results in an estimated $30 billion in direct medical costs due to back-related health care resource utilization 42,63 and up to $20 billion annually in indirect costs due to lost productivity. 2 A considerable number of patients require surgery for lumbar degenerative conditions to restore functional and work-related capacity. 1,17,62,67 Several prospective and randomized controlled trials have shown the efficacy of surgical treatment, 1,17,65,67 but other studies have demonstrated that up to 25% of patients experience minimal improvement in quality of life (QOL), 46,58,52 and up to 10% experience a major complication or require hospital readmission after surgery.…”

Does Workers’ Compensation Status Affect Outcomes after Lumbar Spine Surgery? A Systematic Review and Meta-Analysis

“…Consistently with previous studies, we reported that WC patients tended to exhibit higher post-operative pain (RR = 1.79) and disability (RR = 1.38) as well as lower satisfaction after surgery (RR = 2.10) compared to NWC patients. WC patients demonstrated also a delayed RTW (RR = 1.68) with a significant socioeconomic burden on both work insurances and employers [ 49 ]. This latter data is particularly important when considering that the annual expenditure for treating LBP in the United States is greater than $100 billion, with lost wages and reduced productivity accounting for approximately two thirds of the amount [ 50 ].…”