340 Effect of Worker's Compensation Status on Pain, Disability, Quality of Life, and Return to Work After Lumbar Spine Surgery: A One-Year Propensity-Matched Analysis

Abstract

INTRODUCTION: Compensation and litigation have been shown to adversely impact prognoses in a vast range of health conditions. Low back pain (LBP) is currently the most frequent reason for workers' compensation (WC) claims. METHODS: Complete datasets for patients who underwent 1 to 4-level lumbar spinal fusion or decompression alone were retrospectively mined from the National Quality Outcomes Database (QOD), which included one-year patient-reported outcomes (PROs) from over 200 hospital systems collected from 2012-2021. Population demographics, perioperative safety, facility utilization, patient satisfaction, disability, pain, EuroQol-5D (EQ-5D) quality-of-life, and return-to-work rates were compared between cohorts for both subgroups. Statistical significance was set at p < 0.05. RESULTS: 29,652 patients were included: Laminectomy (16,939 non-WC, 615 WC); Fusion (11,767 non-WC, 331 WC). WC patients were more frequently male, minority race, younger, less educated, more frequently a smoker, healthier ASA grade, with greater baseline VAS and ODI scores (p < 0.001). One-year postoperative improvements in VAS, ODI, QALY, return to work rates, and satisfaction were all significantly worse for WC vs non-WC patients for both procedures. After adjusting for baseline differences via propensity matching, WC vs non-WC patients continued to demonstrate worse 3- and 12-month VAS and ODI, reduced 12-month QALY-gain, and delayed return to work after both procedure types. CONCLUSIONS: WC status was associated with significantly greater residual disability and pain post-operatively, lower quality of life, and delayed return to work. Utilizing resources to identify the negative influences on outcomes for WC patients may be of value in preoperative optimization and could yield better outcomes in these patients.