The Relationship between Recurrent Spine Surgery and Employment Status

Abstract

Background: What is the quantitative relationship between repeated surgical intervention and unemployment in the spine surgery population? And, does the literature pay sufficient attention to this important aspect of spine surgery outcome? Methods: This was a retrospective review of 905 patients of working age undergoing one of three types of spine surgery. The index surgery at the time of the study was either on the cervical or lumbar spine. We retrospectively collected data on patients’ employment status and history of prior spine surgery. In this study, history of prior spine surgery was coded using two nominal (categorical) variables: The number of previous spine surgeries (0, 1, 2, ≥3) and the variability of location of previous spine surgeries (cervical, lumbar). We also looked into scientific publications related to spine surgery and probed “employment” and “reoperation” awareness in randomized controlled trials (RCTs). In addition, we queried some common factors that are known to play an important role in exacerbating the unemployment problem, such as opioid (ab)use and depression. Results: The unemployment rate was 19.4% among males and 34.8% among females. Unemployment rate correlated with the number of previous spine surgery (r = 0.077, p = 0.020), opioid use (r = 0.080, p = 0.017) and being on antidepressants (r = 0.119, p = 0.000). The unemployment rate was sta-tistically different (χ2 = 10.656, p = 0.014) among patients with different numbers of previous spine surgeries: 25.6% of de novo patients versus 28.1% of patients with one previous spine surgery, 32.7% of patients with two previous spine surgeries and 48.7% of patients with three or more previous spine surgeries. Females had significantly higher unemployment rate if they had three or more previous spine surgeries in their past (31.4%, 34.4%, 46.2% versus 83.3%, χ2 = 21.841, p = 0.000). Unemployment rate was as high as 90% in female patients with ≥3 surgeries on different regions of the spine and receiving antidepressants. Among randomized controlled trials addressing spine surgery in humans and published in English, 10.4% of reported studies mentioned opioids in their text, 4.1% (23/566) mentioned reoperation, 1.4% (8/566) mentioned employment, and none mentioned antidepressants. Conclusion: Females’ employment status is more sensitive to repeated surgical intervention, regardless of the part of the spine being targeted, reaching close to ten times the general population’s unemployment rate (83.3% versus 8%). On the other hand, a small percentage of randomized controlled trials pertaining to spine surgery deals with employment issues and reoperation rate in their outcome analysis