Impact of occupational characteristics on return to work for employed patients after elective lumbar spine surgery.

dc.contributor.author

Khan, Inamullah

dc.contributor.author

Bydon, Mohamad

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Archer, Kristin R

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Sivaganesan, Ahilan

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Asher, Anthony M

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Alvi, Muhammad Ali

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Kerezoudis, Panagiotis

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Knightly, John J

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Foley, Kevin T

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Bisson, Erica F

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Shaffrey, Christopher

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Asher, Anthony L

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Spengler, Dan M

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Devin, Clinton J

dc.date.accessioned

2023-06-20T12:40:12Z

dc.date.available

2023-06-20T12:40:12Z

dc.date.issued

2019-12

dc.date.updated

2023-06-20T12:40:07Z

dc.description.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.
dc.identifier

S1529-9430(19)30936-2

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1529-9430

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1878-1632

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https://hdl.handle.net/10161/28178

dc.language

eng

dc.publisher

Elsevier BV

dc.relation.ispartof

The spine journal : official journal of the North American Spine Society

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10.1016/j.spinee.2019.08.007

dc.subject

Lumbar Vertebrae

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Humans

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Postoperative Complications

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Neurosurgical Procedures

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Adult

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Aged

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Middle Aged

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Unemployment

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Female

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Male

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Intervertebral Disc Displacement

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Intervertebral Disc Degeneration

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Return to Work

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Elective Surgical Procedures

dc.title

Impact of occupational characteristics on return to work for employed patients after elective lumbar spine surgery.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher|0000-0001-9760-8386

pubs.begin-page

1969

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1976

pubs.issue

12

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Duke

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School of Medicine

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Clinical Science Departments

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Orthopaedic Surgery

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Neurosurgery

pubs.publication-status

Published

pubs.volume

19

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