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

Asher, Anthony L

Devin, Clinton J

Archer, Kristin R

Chotai, Silky

Parker, Scott L

Bydon, Mohamad

Nian, Hui

Harrell, Frank E

Speroff, Theodore

Dittus, Robert S

Philips, Sharon E

Shaffrey, Christopher I

Foley, Kevin T

McGirt, Matthew J

2023-07-09T21:09:29Z

2023-07-09T21:09:29Z

2017-10

2023-07-09T21:09:26Z

OBJECTIVE 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. METHODS 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). RESULTS 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. CONCLUSIONS 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.

1547-5654

1547-5646

https://hdl.handle.net/10161/28372

eng

Journal of Neurosurgery Publishing Group (JNSPG)

Journal of neurosurgery. Spine

10.3171/2016.8.spine16527

Lumbar Vertebrae

Humans

Back Pain

Pain, Postoperative

Pain Measurement

Prognosis

Treatment Outcome

Registries

Longitudinal Studies

Follow-Up Studies

Prospective Studies

Decision Making

Models, Theoretical

Databases, Factual

Adult

Middle Aged

Female

Male

Intervertebral Disc Degeneration

Return to Work

Elective Surgical Procedures

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

Journal article

Shaffrey, Christopher I|0000-0001-9760-8386

370

381

4

Duke

School of Medicine

Clinical Science Departments

Orthopaedic Surgery

Neurosurgery

Published

27