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

Anthony L. Asher, Clinton J. Devin, Kristin R. Archer, Silky Chotai, Scott L. Parker, Mohamad Bydon, Hui Nian, Frank E. Harrell, Theodore Speroff, Robert S. Dittus, Sharon E. Philips, Christopher I. Shaffrey, Kevin Foley, Matthew J. McGirt

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

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 fnancial 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 defned 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 ftted 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.

Original languageEnglish (US)
Pages (from-to)370-381
Number of pages12
JournalJournal of Neurosurgery: Spine
Volume27
Issue number4
DOIs
StatePublished - Oct 1 2017

Fingerprint

Return to Work
Databases
Spine
Back Pain
Registries
Labor Presentation
Liability Insurance
Education
Workers' Compensation
Aptitude
Occupations
Proportional Hazards Models
African Americans
Leg
Decision Making
Communication
Demography
Efficiency
Costs and Cost Analysis
Pain

All Science Journal Classification (ASJC) codes

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

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; McGirt, Matthew J.

In: Journal of Neurosurgery: Spine, Vol. 27, No. 4, 01.10.2017, p. 370-381.

Research output: Contribution to journalArticle

Asher, AL, Devin, CJ, Archer, KR, Chotai, S, Parker, SL, Bydon, M, Nian, H, Harrell, FE, Speroff, T, Dittus, RS, Philips, SE, Shaffrey, CI, Foley, K & McGirt, MJ 2017, 'An analysis from the Quality Outcomes Database, Part 2. Predictive model for return to work after elective surgery for lumbar degenerative disease', Journal of Neurosurgery: Spine, vol. 27, no. 4, pp. 370-381. https://doi.org/10.3171/2016.8.SPINE16527
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 ; McGirt, Matthew J. / An analysis from the Quality Outcomes Database, Part 2. Predictive model for return to work after elective surgery for lumbar degenerative disease. In: Journal of Neurosurgery: Spine. 2017 ; Vol. 27, No. 4. pp. 370-381.
@article{de038913cfbe477eb3dbaf5fc50ddf38,
title = "An analysis from the Quality Outcomes Database, Part 2. Predictive model for return to work after elective surgery for lumbar degenerative disease",
abstract = "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 fnancial 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 defned 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 ftted 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.",
author = "Asher, {Anthony L.} and Devin, {Clinton J.} and Archer, {Kristin R.} and Silky Chotai and Parker, {Scott L.} and Mohamad Bydon and Hui Nian and Harrell, {Frank E.} and Theodore Speroff and Dittus, {Robert S.} and Philips, {Sharon E.} and Shaffrey, {Christopher I.} and Kevin Foley and McGirt, {Matthew J.}",
year = "2017",
month = "10",
day = "1",
doi = "10.3171/2016.8.SPINE16527",
language = "English (US)",
volume = "27",
pages = "370--381",
journal = "Journal of Neurosurgery: Spine",
issn = "1547-5654",
publisher = "American Association of Neurological Surgeons",
number = "4",

}

TY - JOUR

T1 - An analysis from the Quality Outcomes Database, Part 2. Predictive model for return to work after elective surgery for lumbar degenerative disease

AU - Asher, Anthony L.

AU - Devin, Clinton J.

AU - Archer, Kristin R.

AU - Chotai, Silky

AU - Parker, Scott L.

AU - Bydon, Mohamad

AU - Nian, Hui

AU - Harrell, Frank E.

AU - Speroff, Theodore

AU - Dittus, Robert S.

AU - Philips, Sharon E.

AU - Shaffrey, Christopher I.

AU - Foley, Kevin

AU - McGirt, Matthew J.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - 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 fnancial 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 defned 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 ftted 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.

AB - 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 fnancial 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 defned 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 ftted 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.

UR - http://www.scopus.com/inward/record.url?scp=85030707399&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85030707399&partnerID=8YFLogxK

U2 - 10.3171/2016.8.SPINE16527

DO - 10.3171/2016.8.SPINE16527

M3 - Article

VL - 27

SP - 370

EP - 381

JO - Journal of Neurosurgery: Spine

JF - Journal of Neurosurgery: Spine

SN - 1547-5654

IS - 4

ER -