The Timing of Surgery Affects Return to Work Rates in Patients With Degenerative Lumbar Stenosis in a Workers' Compensation Setting. Issue 10 (December 2017)

• Record Type: Journal Article
• Authors: Tye, Erik Y.; Anderson, Joshua T.; Haas, Arnold R.; Percy, Rick; Woods, Stephen T.; Ahn, Uri M.; Ahn, Nicholas U.
• Is Part Of: Clinical spine surgery. Volume 30:Issue 10(2017)
• Publication Date: 2017-12
• Subjects: lumbar spinal stenosis -- workers' compensation -- time to surgery -- clinical outcomes -- return to work; Spinal cord -- Diseases -- Periodicals; Spinal cord -- Surgery -- Periodicals; 617.56059
• DOI: 10.1097/BSD.0000000000000573
• Languages: English
• ISSNs: 2380-0186

Abstract

Abstract : Study Design: Retrospective Cohort Study. Objective: The objective of this study is to determine how time to surgery affects outcomes for degenerative lumbar stenosis (DLS) in a workers' compensation (WC) setting. Summary of Background Data: WC subjects are known to be a clinically distinct population with variable outcomes following lumbar surgery. No study has examined the effect of time to surgery in this clinically distinct population. Materials and Methods: A total of 227 Ohio WC subjects were identified who underwent primary decompression for DLS between 1993 and 2013. We allocated patients into 2 groups: those that received operative decompression before and after 1 year of symptom onset. Our primary outcome was, if patients were able to make a stable return to work (RTW). The authors classified subjects as RTW if they returned within 2 years after surgery and remained working for >6 months. Results: The early cohort had a significantly higher RTW rate [50% (25/50) vs. 30% (53/117); P =0.01]. A logistic regression was performed to identify independent variables that predicted RTW status. Our regression model showed that time to surgery remained a significant negative predictor of RTW status ( P =0.04; odds ratio, 0.48; 95% confidence interval, 0.23–0.91). Patients within the early surgery cohort cost on average, $37, 332 less in total medical costs than those who opted for surgery after 1 year ( P =0.01). Furthermore, total medical costs accrued over 3 years after index surgery was on average, $13, 299 less when patients received their operation within 1 year after symptom onset ( P =0.01). Conclusions: Overall, time to surgery had a significant impact on clinical outcomes in WC subjects receiving lumbar decompression for DLS. Patients who received their operation within 1 year had a higher RTW rate, lower medical costs, and lower costs accrued over 3 years after index surgery. The results presented can perhaps be used to guide surgical decision-making and provide predictive value for the WC population.