Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P126. Early surgery yields better outcomes after cervical fusion for radiculopathy in a workers’ compensation population

Abstract

BACKGROUND CONTEXT Patients with workers’ compensation (WC) undergoing cervical surgery have been shown to have inferior outcomes compared with the general population. Previous studies have suggested that the reason behind this discrepancy is multifactorial. Within this clinically distinct population, the ability to return to work (RTW) is particularly important, especially when considering that the economic ramifications from treating patients with cervical injuries. Given the high costs associated with both nonoperative and operative treatments for cervical conditions in the WC population as well as the risk of residual disability, it is critically important to identify whether time to surgery has any significant effect on the clinical and financial outcomes in this population. PURPOSE Determine if outcomes of surgery for cervical radiculopathy in a WC population are affected by time to surgery. More specifically, we studied differences in RTW rates, chronic opioid use, depression, disability and medical costs in patients receiving cervical fusion based on the time between the index injury and their index surgery. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Patients included were subjects qualified for WC benefits for work-related injuries. The study population included patients underwent cervical fusion for radiculopathy and had a minimum of 3years of follow-up after surgery. OUTCOME MEASURES Return to work, opioid prescription use, newly diagnosed clinical depression, permanent disability, reoperation and total medical costs incurred at 3years follow-up after surgery. METHODS A total of 3,171 Ohio WC subjects were identified who underwent cervical fusion for radiculopathy between 1993 and 2013. We allocated patients into 4 groups based on the time from injury to surgery (Time to surgery [TTS]): TT 3years. Logistic regression was used to assess TTS correlation with the outcomes of interest: Return to work (RTW), opioid prescription use, newly diagnosed clinical depression, permanent disability, reoperation and total medical costs incurred at 3years follow-up after surgery. RESULTS Univariate analysis showed, Shorter TTS was associated with higher RTW rate (p=.0001), lower chronic opioid use (p=.0001), lower residual disability (p=.0001), and lower medical costs (p=.0001). Logistic regression showed, after ajusting for other covariates, TTS was significant predictor of stable RTW (OR=0.67; 95%CI [0.59-0.76], p=.0001), residual permanent disability (OR=1.38; 95%CI [0.99-1.92], p=.056), and chronic opioid use (OR=1.46; 95%CI [0.53–0.70], p=.0001). However, it was not a predictor of postoperative depression or reoperation within 3years after surgery. CONCLUSIONS Overall, time to surgery had a significant impact on clinical outcomes in WC subjects receiving cervical fusion for radiculopathy. Patients who received their operation within 1 year had a higher RTW rate, lower use of opioid prescriptions, and overall lower medical costs at 3years after index surgery. The results presented can perhaps be used to guide surgical decision-making and provide predictive value for the WC population.