252. Differences in clinically important physical function improvement in workers’ compensation population

Abstract

BACKGROUND CONTEXT Patients receiving workers’ compensation (WC) demonstrate a propensity for poorer postoperative outcomes. PURPOSE This study determined rates of minimum clinically important difference (MCID) achievement in patients receiving WC following transforaminal interbody lumbar fusion (TLIF). STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE A total of 121 patients, out of 634, undergoing primary, single level TLIF with 29 receiving WC and 92 that were non-WC. OUTCOME MEASURES Visual analog score (VAS) for back and leg, Oswestry Disability Index (ODI), 12-Item Short Form Physical Component Summary (SF-12 PCS), and Patient Reported Outcome Measurement Information System (PROMIS) METHODS A retrospective review of a prospective surgical registry for patients undergoing primary, single level TLIF from 2015 to 2020 was performed. Patient reported outcome measures (PROM) were collected pre- and postoperatively as VAS for back and leg, ODI, SF-12 PCS and PROMIS. Patients were separated into two groups based on insurance collected: WC or Non-WC. To account for differences in demographic characteristics between groups and types of procedures, a propensity score match was performed. Postoperative improvement was assessed for all PROMs using paired t-test and intergroup differences were determined by linear regression. Achievement of MCID was calculated by comparison of the difference in preoperative and postoperative PROM scores with established values and any intergroup differences assessed using Chi-squared analysis. RESULTS Following propensity score matching, a total of 121 patients, out of 634, were included with 29 receiving WC and 92 that were non-WC. Mean age was 53.5 years with majority being male (63.6%). Groups differed in spinal diagnosis of isthmic spondylolisthesis (p=0.044). Following propensity score matching groups differed only in age, gender, and ethnicity (all p<0.05). WC patients demonstrated significantly poorer PROM values at all timepoints except for preoperative VAS back (p=0.297) and VAS leg (p=0.475). Groups differed in MCID achievement for VAS back and leg at 12-weeks (both p<0.05), ODI at 12-weeks (p=0.013) and 6-months (p=0.024), and SF-12 PCS at 6-months (p<0.001). Overall achievement of MCID was significantly lower for the WC cohort for VAS back (p=0.040), ODI (p=0.001), SF-12 PCS (p=0.010), and PROMIS PF (p=0.039). CONCLUSIONS Workers’ compensation patients demonstrated poorer postoperative outcomes at majority of timepoints. Additionally, a significantly lower rate of MCID achievement for back pain, disability, and physical function was observed overall and at intermittent timepoints for WC patients. WC patients may require alternative preoperative counseling regarding expectations for improvement following TLIF. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Patients receiving workers’ compensation (WC) demonstrate a propensity for poorer postoperative outcomes. This study determined rates of minimum clinically important difference (MCID) achievement in patients receiving WC following transforaminal interbody lumbar fusion (TLIF). Retrospective cohort. A total of 121 patients, out of 634, undergoing primary, single level TLIF with 29 receiving WC and 92 that were non-WC. Visual analog score (VAS) for back and leg, Oswestry Disability Index (ODI), 12-Item Short Form Physical Component Summary (SF-12 PCS), and Patient Reported Outcome Measurement Information System (PROMIS) A retrospective review of a prospective surgical registry for patients undergoing primary, single level TLIF from 2015 to 2020 was performed. Patient reported outcome measures (PROM) were collected pre- and postoperatively as VAS for back and leg, ODI, SF-12 PCS and PROMIS. Patients were separated into two groups based on insurance collected: WC or Non-WC. To account for differences in demographic characteristics between groups and types of procedures, a propensity score match was performed. Postoperative improvement was assessed for all PROMs using paired t-test and intergroup differences were determined by linear regression. Achievement of MCID was calculated by comparison of the difference in preoperative and postoperative PROM scores with established values and any intergroup differences assessed using Chi-squared analysis. Following propensity score matching, a total of 121 patients, out of 634, were included with 29 receiving WC and 92 that were non-WC. Mean age was 53.5 years with majority being male (63.6%). Groups differed in spinal diagnosis of isthmic spondylolisthesis (p=0.044). Following propensity score matching groups differed only in age, gender, and ethnicity (all p<0.05). WC patients demonstrated significantly poorer PROM values at all timepoints except for preoperative VAS back (p=0.297) and VAS leg (p=0.475). Groups differed in MCID achievement for VAS back and leg at 12-weeks (both p<0.05), ODI at 12-weeks (p=0.013) and 6-months (p=0.024), and SF-12 PCS at 6-months (p<0.001). Overall achievement of MCID was significantly lower for the WC cohort for VAS back (p=0.040), ODI (p=0.001), SF-12 PCS (p=0.010), and PROMIS PF (p=0.039). Workers’ compensation patients demonstrated poorer postoperative outcomes at majority of timepoints. Additionally, a significantly lower rate of MCID achievement for back pain, disability, and physical function was observed overall and at intermittent timepoints for WC patients. WC patients may require alternative preoperative counseling regarding expectations for improvement following TLIF.