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

Inamullah Khan, Mohamad Bydon, Kristin R. Archer, Ahilan Sivaganesan, Anthony M. Asher, Muhammad Ali Alvi, Panagiotis Kerezoudis, John J. Knightly, Kevin Foley, Erica F. Bisson, Christopher Shaffrey, Anthony L. Asher, Dan M. Spengler, Clinton J. Devin

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalSpine Journal
DOIs
StateAccepted/In press - Jan 1 2019

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Return to Work
Spine
Workers' Compensation
Databases
Back Pain
Occupations
Logistic Models
Spondylolisthesis
Pain
Sick Leave
Pseudarthrosis
Low Back Pain
Insurance
Reoperation
Workplace
Registries
Leg

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Khan, I., Bydon, M., Archer, K. R., Sivaganesan, A., Asher, A. M., Alvi, M. A., ... Devin, C. J. (Accepted/In press). Impact of occupational characteristics on return to work for employed patients after elective lumbar spine surgery. Spine Journal. https://doi.org/10.1016/j.spinee.2019.08.007

Impact of occupational characteristics on return to work for employed patients after elective lumbar spine surgery. / Khan, Inamullah; Bydon, Mohamad; Archer, Kristin R.; Sivaganesan, Ahilan; Asher, Anthony M.; Alvi, Muhammad Ali; Kerezoudis, Panagiotis; Knightly, John J.; Foley, Kevin; Bisson, Erica F.; Shaffrey, Christopher; Asher, Anthony L.; Spengler, Dan M.; Devin, Clinton J.

In: Spine Journal, 01.01.2019.

Research output: Contribution to journalArticle

Khan, I, Bydon, M, Archer, KR, Sivaganesan, A, Asher, AM, Alvi, MA, Kerezoudis, P, Knightly, JJ, Foley, K, Bisson, EF, Shaffrey, C, Asher, AL, Spengler, DM & Devin, CJ 2019, 'Impact of occupational characteristics on return to work for employed patients after elective lumbar spine surgery', Spine Journal. https://doi.org/10.1016/j.spinee.2019.08.007
Khan, Inamullah ; Bydon, Mohamad ; Archer, Kristin R. ; Sivaganesan, Ahilan ; Asher, Anthony M. ; Alvi, Muhammad Ali ; Kerezoudis, Panagiotis ; Knightly, John J. ; Foley, Kevin ; Bisson, Erica F. ; Shaffrey, Christopher ; Asher, Anthony L. ; Spengler, Dan M. ; Devin, Clinton J. / Impact of occupational characteristics on return to work for employed patients after elective lumbar spine surgery. In: Spine Journal. 2019.
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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.",
author = "Inamullah Khan and Mohamad Bydon and Archer, {Kristin R.} and Ahilan Sivaganesan and Asher, {Anthony M.} and Alvi, {Muhammad Ali} and Panagiotis Kerezoudis and Knightly, {John J.} and Kevin Foley and Bisson, {Erica F.} and Christopher Shaffrey and Asher, {Anthony L.} and Spengler, {Dan M.} and Devin, {Clinton J.}",
year = "2019",
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TY - JOUR

T1 - Impact of occupational characteristics on return to work for employed patients after elective lumbar spine surgery

AU - Khan, Inamullah

AU - Bydon, Mohamad

AU - Archer, Kristin R.

AU - Sivaganesan, Ahilan

AU - Asher, Anthony M.

AU - Alvi, Muhammad Ali

AU - Kerezoudis, Panagiotis

AU - Knightly, John J.

AU - Foley, Kevin

AU - Bisson, Erica F.

AU - Shaffrey, Christopher

AU - Asher, Anthony L.

AU - Spengler, Dan M.

AU - Devin, Clinton J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

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