287 What is the Velocity of Return-to-work After Circumferential Minimally-Invasive Surgery Versus Open Correction for Adult Spinal Deformity?

Abstract

INTRODUCTION: While faster recovery is a touted benefit of minimally-invasive spinal operations, these differences have been poorly described for return-to-work after larger fusion constructs for adult spinal deformity. METHODS: Adult spinal deformity (ASD) patients =18 yr were queried from a multicenter, prospective database across the USA. To ensure equal cohorts for comparing the impact of MIS vs. open correction technique, propensity score matched gender, age, BMI, pelvic incidence-lumbar lordosis mismatch, and sagittal vertical axis. Of 190 patients with baseline surveys, 173 respondents (91.0%) had both baseline employment and 2-year follow-up. The open and cMIS cohorts were compared with a chi-squared test. The rate of return-to-work was calculated via discrete-time proportional hazards model—reporting an adjusted odds ratio (ORadj)—at three follow-up intervals: 6 weeks, 1-year, and 2-years. RESULTS: Of 173 patients, baseline employment status was nearly equal between open (n = 85) vs cMIS (n = 88) cohorts: employed (20.0% vs 21.5%), unemployed (3.5% vs 4.5%), disabled (4.7% vs 6.8%), and retired (71.7% vs 67.0%) (p = 0.888). The number of employed patients between the open vs cMIS cohort statistically significantly differed at 1-year (10.5% vs 21.5%, p = 0.049), but not at 6 weeks (14.1% vs 15.9%, p = 0.741) or 2-years (14.1% vs 19.3%, p = 0.277). The velocity of return-to-work did not differ (OR = 1.2, p = 0.549). In a sub-analysis of 36 patients who were employed at baseline, the number of employed patients between the open vs cMIS cohort statistically significantly differed at 1-year (47.0% vs 89.4%, p = 0.006), but not at 6 weeks (70.5% vs 73.6%, p = 0.636) or 2-years (58.8% vs 78.9%, p = 0.191). The velocity of return-to-work was also similar (ORadj = 1.57, p = 0.481). CONCLUSIONS: Despite an equivalent baseline employment status, more patients in the cMIS cohort were employed at 1-year; however, there was no difference at 2-years. Similar trends were appreciated in a sub-analysis of patients who were employed at baseline.