213. Adult spinal deformity surgery is associated with increased productivity and decreased absenteeism from work and school

Abstract

<h3>BACKGROUND CONTEXT</h3> Adult spinal deformity (ASD) patients experience markedly decreased health-related quality of life along many dimensions. <h3>PURPOSE</h3> We hypothesized that ASD surgery would be associated with improved work- and school-related productivity, as well as decreased rates of absenteeism. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> Only patients eligible for 2-year follow-up were included, and those with a history of previous spinal fusion were excluded. <h3>OUTCOME MEASURES</h3> The primary outcome measures in this study were SRS-22r questions 9 ("What is your current level of work/school activity?") and 17 ("In the last 3 months have you taken any days off of work, including household work, or school because of back pain?"). <h3>METHODS</h3> A repeated measures mixed linear regression was used to analyze responses over time among patients managed operatively (OP) vs nonoperatively (NON-OP). Results were further stratified by baseline employment status, age, SVA, PI-LL, and deformity curve type. <h3>RESULTS</h3> In total, 1,188 patients were analyzed. Of those, 66.6% (n=792) were managed operatively. The vast majority (78.9%, n=934) were female. Patients were relatively evenly distributed across age groups (27.6% 0-49; 21.1% 50-59; 30.1% 60-69; 21.2% ≥70). At baseline, the mean percentage of activity at work/school was 56.4% (SD 35.4%), and the mean days off from work/school over the past 90 days was 1.6 (SD 1.8). Patients undergoing ASD surgery exhibited an 18.1% absolute increase in work/school productivity at 2-year follow-up vs baseline (p<0.0001), while no significant change was observed for the nonoperative cohort (p>0.5). Similarly, the OP cohort experienced 1.1 fewer absent days over the past 90 days at 2 years vs baseline (p<0.0001), while the NON-OP cohort showed no such difference (p>0.3). These differences were largely preserved after stratifying by baseline employment status, age group, SVA, PI-LL, and deformity curve type. <h3>CONCLUSIONS</h3> ASD patients managed operatively exhibited an average increase in work/school productivity of 18.1% and decreased absenteeism of 1.1 per 90 days at 2-year follow-up, while patients managed non-operatively did not exhibit change from baseline. Given the age distribution of patients in this study, these findings should be interpreted as pertaining primarily to obligations at work or within the home. Further study of the direct and indirect economic benefits of ASD surgery to patients is warranted. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.