Work-related outcomes after lumbar fusion

Abstract

Purpose of study: To date, there are few published data concerning work-related outcomes in patients undergoing lumbar fusion. The present observational study was designed to evaluate specific work-related outcomes in a population-based cohort of patients undergoing lumbar fusion.Methods used: A population-based database of 815 prospectively identified lumbar fusion patients was queried for patients with complete 2-year follow-up. From the resultant subset of 292 patients with complete prospective data, a study group of 104 patients met inclusion criteria and completed a detailed work outcome questionnaire. Baseline patient self-assessment and physician questionnaire data included standard sociodemographic information, measures of back and leg pain, smoking history, general work history, compensation/litigation status and Short Form (SF)-36. Baseline measures were compared with similar outcome measures (including SF-36) administered at 6, 12 and 24 months after surgery. Independent associations between baseline characteristics and measures of patient satisfaction and work outcome were identified.of findings: Among the study group, 67% of patients were satisfied with treatment, and 54% of patients were satisfied with overall improvement, 46% experienced decrease in pain and 51% experienced improved functioning. Factors negatively associated with at least one self-assessed outcome category included male gender, overweight/obese body mass index, workers compensation coverage, greater preoperative leg pain and prior lumbar surgery. Work-related outcomes showed little correlation between first return to work and successful return to work at 2-year follow-up. Although several factors (age less than 50 years, preoperative narcotics use, workers compensation coverage, involvement with litigation, moderate/heavy job labor, time off from work before surgery and preoperative leg pain) were negatively associated with first return to work. Only workers compensation coverage and involvement with litigation were associated with a less successful work outcome at 2 years. Despite a negative association, 68% of patients with workers compensation coverage did return to work and 48% had an ultimately successful return to work at 2 years.Relationship between findings and existing knowledge: To our knowledge, the present study represents the first formalized attempt to quantify detailed work-related outcomes in a population-based cohort of patients undergoing lumbar fusion.Overall significance of findings: Our report confirms previous research studies showing satisfactory self-assessed patient outcomes in a large proportion of patients after lumbar fusion. The present effort demonstrates important differences in work outcomes and measures of patient satisfaction as they relate to baseline patient variables. These initial findings underscore the need for additional work outcomes research and a standardized array of work outcome instruments.Disclosures: No disclosures.Conflict of interest: William R. Klemme, MD, consultant; Leila S. Nelson, PhD, other support; Edgar G. Dawson, MD, consultant; J. Kenneth Burkus, MD, consultant; Kevin T. Foley, MD, consultant; Stephen M. Papadopoulos, MD, consultant PhDx Systems, Inc.