Worker's Compensation Patients Research Articles

Quantifying value loss due to presenteeism and absenteeism in workers’ compensation spinal patients

BackgroundRecent studies suggest that better outcomes in work productivity following spine surgery eventually offset the higher cost of treatment. By analyzing preoperative and postoperative changes in work productivity, studies can determine if surgery is cost-effective and give patients valuable information about treatment. Prior studies reviewing outcomes in work performance after spine surgery have largely excluded patients on workers’ compensation from the overall cost analysis. MethodsA retrospective review of 92 eligible patients was conducted. Evaluation of the EHR identified presenteeism and absenteeism from designated work restrictions. Statistical analyses were conducted using JMP Pro 17. Results84 (83%) spinal surgery cases were able to return to work, 60 (59%) were able to return to work with no restrictions, 26 (26%) received permanent work restrictions, and 12 (12%) were still undergoing treatment. 86 (85%) experienced presenteeism and 99 (98%) experienced absenteeism. Of the cases that were able to return to work without permanent work restrictions, the mean presenteeism length postoperatively was 287.4 days (median 191 days) and the mean absenteeism length postoperatively was 232.5 days (median 142 days). 72 patients were identified as having sedentary or non-sedentary labor. After excluding outliers, the average return-to-work length was 988.62 days for patients with sedentary employment types and 952.15 days for patients with non-sedentary employment types (p=0.116). ConclusionFollowing spinal surgery, our worker's compensation patient population's return-to-work rate was at an average of 232.5 days (median of 142 days) for 83% of patients included in this study. This exhibited worse outcomes than a previous study's measurement excluding worker's compensation patients. Presenteeism length within our population contributed more to decreased work productivity postoperatively than absenteeism length. Our results found no significant difference in return-to-work length between patients with sedentary and non-sedentary employment types.

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

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.

289 Mental Health Comorbidities in Workers Compensation Patients and the Effect on Pain, Disability, Quality of Life, and Return to Work After Lumbar Spine Surgery

INTRODUCTION: Outcomes after lumbar spine surgery in workers’ compensation (WC) patients have been reported to be worse than the general population. Anxiety and depression are modifiable risk factors that also adversely affect outcomes after lumbar spine surgery. METHODS: We queried a nationwide, prospective surgical outcomes registry (AANS-QOD) for all patients undergoing lumbar spine surgery at over 200 hospital systems from 2012 to 2021. Perioperative safety, facility utilization, one-year patient-reported outcomes (pain, disability, and quality-of-life), and return to work (RTW) were measured as a function of WC and mental health comorbidity status. RESULTS: A total of 27,525 patients (1018 WC, 26,507 non-WC) undergoing 1-4 level lumbar spine surgery (14,914 laminectomy, 12,611 fusion) were reviewed. WC patients were younger, healthier (lower ASA grade), more likely to be minorities, less educated, more likely to smoke, and had greater baseline back pain, disability, and quality of life compared to non-WC patients. The prevalence of anxiety and depression was similar between groups. WC patients had worse outcomes for all measures and lower rates of RTW compared to non-WC patients. WC patients with anxiety and depression demonstrated even greater disparities in all outcomes. After propensity matching, WC patients with anxiety or depression (n = 107) continued to demonstrate significantly worse outcomes in comparison to WC patients without anxiety or depression (n = 107). CONCLUSIONS: Disparities in outcomes after lumbar spine surgery in WC patients are exacerbated in patients with anxiety and depression. WC patients with mental health comorbidities receive the least benefit from lumbar spine surgery and may represent the most vulnerable subset of patients with spinal pathology. Addressing mental health comorbidities preoperatively may represent an opportunity for valuable resource allocation and surgical optimization in the WC population.

Mental health comorbidities in workers' compensation patients and the effect on pain, disability, quality of life, and return to work after lumbar spine surgery.

The impact of mental health comorbidities on outcomes after lumbar spine surgery in workers' compensation (WC) patients has not been robustly explored. The goal of this study was to examine the impact of mental health comorbidities on pain, disability, quality of life, and return to work after lumbar spine surgery in WC patients. A nationwide, prospective surgical outcomes registry (National Neurosurgery Quality Outcomes Database [N2QOD]) was queried for all patients who underwent 1- to 4-level lumbar decompression and/or fusion from 2012 to 2021. Patients were stratified on the basis of compensation status into non-WC (25,507) and WC (1018) cohorts. Baseline demographic data, perioperative safety data, and patient-reported outcome measures were compared between groups. The WC cohort was further subdivided on the basis of mental health status into patients with anxiety and depression (n = 107) and those without anxiety and depression (n = 911). Propensity matching was used to generate parity between these subgroups, generating 214 patients (107 pairs) for analysis. Perioperative safety, facility utilization, 1-year patient-reported outcomes (back and leg pain, disability, and quality of life), and return to work were measured as a function of WC and mental health comorbidity status. A total of 26,525 patients (25,507 non-WC and 1018 WC) who underwent 1- to 4-level lumbar spine surgery were reviewed. WC patients were younger, healthier (lower American Society of Anesthesiologists class), more likely to be minorities, less educated, and more likely to smoke and had greater baseline back pain, disability, and quality of life compared to non-WC patients. The prevalence of anxiety and depression was similar between groups (11%). WC patients had worse outcomes for all measures and lower rates of return to work compared to non-WC patients. WC patients with anxiety and depression demonstrated even greater disparities in all outcomes. After propensity matching, WC patients with anxiety and depression continued to demonstrate significantly worse outcomes in comparison to WC patients without anxiety and depression. Disparities in outcomes after lumbar spine surgery in WC patients are exacerbated in patients with anxiety and depression. WC patients with mental health comorbidities receive the least benefit from lumbar spine surgery and may represent the most vulnerable subset of patients with spine pathology. Addressing mental health comorbidities preoperatively may represent an opportunity for valuable resource allocation and surgical optimization in the WC population.

The Workers Compensation Burden: Does Compensation Status Lead to Increased Utilization of Healthcare Resources Following Foot and Ankle Surgery?

Category: Other Introduction/Purpose: The association between workers’ compensation (WC) patients and the increased risk of complications and poor outcomes following orthopaedic procedures has been well documented. Recent studies have shown that WC patients have a higher rate of subsequent pain or injury than non-WC patients following common foot and ankle procedures. Due to the increased risks of complications, poor outcomes, and chronic pain amongst WC patients following orthopaedic procedures, it is possible that these patients consume more healthcare resources than non-WC patients during the post-surgical period. This study aimed to investigate the amount of healthcare resources utilized by WC patients following a foot or ankle procedure compared with a procedure-matched control group. Methods: A retrospective review was conducted of all WC and non-WC patients who had undergone foot (CPT 28001-28899) or ankle (CPT 27600-27899) procedures by a single surgeon from October 2017 through January 2020. Patients were excluded based on age ( < 18 or >70), bilateral procedures, presence of neuropathy, disability, and insufficient follow-up. Data collection included demographic, social, surgical, perioperative follow-up, and complications. Measures of healthcare burden included patient communications, physical encounters, processed documents, overall total prescriptions, the total number of office visits, days to return to work, and days to discharge from the clinic. Data analysis was performed with SPSS version 28. Comparisons were conducted with Mann-Whitney U test, chi-square test, or Fisher’s exact test. Power analysis determined the sample size with a 0.05 alpha level, 0.80 power, and 0.5 effect size. Results: 142 patients met the inclusion criteria including 71 WC patients and 71 non-WC patients. Measures of healthcare burden were greater in WC patients. WC patients had more communication encounters (median 6 vs 3; P<.001), processed documents (median 6 vs 1; P<.001), total prescriptions (median 5 vs 3; P<.001), the total number of office visits (median 8 vs 6; P<.001), days to return to work (median 119 vs 74; P<.001), and days to discharge (median 267 vs 194; P<.001). WC patients were also more likely to have postoperative complications (OR 2.1; P=.045), secondary surgeries (OR 8.2; P<.001), and new complaints during follow-up (OR 1.9; P=.070). WC was less likely to cancel appointments (OR 0.4; P=.028). Conclusion: WC patients demonstrate increased healthcare resource utilization compared to the non-WC population. WC was associated with a higher burden on office staff requiring more time commitment to a single patient. Double the effort was evident on some measured parameters. WC patients also receive more medication prescriptions overall and are more likely to have complications, subsequent surgery, and new complaints remote to the inciting injury.

Narcotic Use and Prescribing Trends Among Workers Compensation Patients Undergoing Foot and Ankle Surgery

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Previous studies have shown that workers compensation patients (WC) have worse outcomes, and higher complications rates after orthopaedic surgery. Despite orthopaedic surgeons being the third highest prescribers of narcotic pain medication in the United States there have been no studies to specifically evaluate narcotic use among the WC population. The purpose of this study was to investigate narcotic use among WC patients who underwent foot or ankle operative procedures compared with a procedure matched control group. Methods: A retrospective review was conducted for WC and non-WC patients ages 18 to 70 years old who underwent foot (CPT 28001-28899) or ankle (CPT 27600-27899) procedures in an orthopaedic surgery practice from October 2017 through January 2020. Data collection included demographics, social, surgical, perioperative follow-up and complications. Outcomes measures were timing and number of narcotic prescriptions, total morphine milligram equivalents (MME), and procedure type. Data analysis was performed with SPSS version 28. Comparisons were conducted with Mann-Whitney U test, chi square test, or Fisher’s exact test. Power analysis determined sample size with a 0.05 alpha level, 0.80 power, and 0.5 effect size. Results: 142 total patients met inclusion criteria, with 71 WC patients and 71 non-WC patients. There were no differences regarding the type of foot or ankle procedure performed (p=0.598). WC patients had double the number of overall narcotic prescriptions (median 2 vs 1; p < 0.001). WC patients were prescribed in total 1,125 oxycodone MME and 871.8 hydrocodone MME (P < 0.001), versus 750 oxycodone MME and 450 hydrocodone MME among the non-WC group (p < .008). There was no difference in the number of tramadol prescriptions (p = 0.571). WC patients experienced more days between the date of last narcotic prescription and both index surgery date (median 27 vs 1, p = 0.001) and initial clinic visit date (median 105 vs 49, p = 0.002). Conclusion: This data demonstrates that WC patients portend worse outcomes and utilize narcotics at twice the rate and for longer periods of time post-operatively than non-WC patients. Increased narcotic use may potentiate narcotic dependence and likely leads to worse outcomes. Treating physicians must be aware of these trends in order to best manage these patients. Physicians may need to have longer discussions with WC patients regarding narcotic use post operatively as well as about outcomes and goals of surgery. Physicians should set early expectations with WC patients and clear limits on the amount of narcotics they are willing to prescribe postoperatively.

Functional Outcomes, Complications, and Failure Rates in Workers’ Compensation Patients Following Hip Arthroscopic Repair: A Systematic Review

Background: Studies on the feasibility of hip arthroscopy in workers’ compensation (WC) patients have been largely inconsistent or limited by study design, necessitating the need for a systematic review. Purpose: We sought to systematically compare clinically significant differences between WC patients and their counterparts in relation to (1) functional outcomes, (2) complications, and (3) failure rates after hip arthroscopy. Methods: We searched MEDLINE, EMBASE, and PubMed databases for studies published between January 1996 and February 2021. In combination with “AND” or “OR” Boolean operators, the following keywords were implemented: “hip arthroscopy,” “workers’ compensation,” “outcomes,” “complications,” “revision,” and “failure rates.” Two reviewers screened eligible studies, evaluated methodological quality, and abstracted data. Results: In the 13 studies pooled, comprising 1874 patients, 276 (14.7%) patients received WC benefits. Twelve studies utilized functional outcomes, 2 studies assessed pain, and 3 studies evaluated satisfaction. Despite scoring lower in these measures preoperatively, WC patients demonstrated significant improvements after hip arthroscopy. Three studies linked compensation with marginally inferior functional scores, but this association was not significant at longer follow-up. Seven studies examined complication incidence, and 6 studies addressed failure rates, with all reporting no significant differences in rates of complications, secondary arthroscopies, or conversion to total hip arthroplasty. Conclusions: The findings of this systematic review suggest that hip arthroscopy offers clinically significant benefits, regardless of WC status. Postoperative results in WC patients, including functional scores, pain, satisfaction, complications, and failure rates, were favorable, and the degree of improvement was at least comparable with their counterparts. Further studies should consider prospective study designs with larger cohorts and extended follow-up.

Effect of workers' compensation status on pain, disability, quality of life, and return to work after anterior cervical discectomy and fusion: a 1-year propensity score-matched analysis.

Patients with workers' compensation (WC) claims are reported to demonstrate poorer surgical outcomes after lumbar spine surgery. However, outcomes after anterior cervical discectomy and fusion (ACDF) in WC patients remain debatable. The authors aimed to compare outcomes between a propensity score-matched population of WC and non-WC patients who underwent ACDF. Patients who underwent 1- to 4-level ACDF were retrospectively reviewed from the prospectively maintained Quality Outcomes Database (QOD). After propensity score matching, 1-year patient satisfaction, physical disability (Neck Disability Index [NDI]), pain (visual analog scale [VAS]), EQ-5D, and return to work were compared between WC and non-WC cohorts. A total of 9957 patients were included (9610 non-WC and 347 WC patients). Patients in the WC cohort were significantly younger (50 ± 9.1 vs 56 ± 11.4 years, p < 0.001), less educated, and were more frequently male, non-Caucasian, and active smokers (29.1% vs 18.1%, p < 0.001), with greater baseline VAS and NDI scores and poorer quality of life (p < 0.001). One-year postoperative improvements in VAS, NDI, EQ-5D, and return-to-work rates and satisfaction were all significantly worse for WC compared with non-WC patients. After adjusting for baseline differences via propensity score matching, WC versus non-WC patients continued to demonstrate worse 3- and 12-month VAS neck pain and NDI (p = 0.010), satisfaction (χ2 = 4.03, p = 0.045), and delayed return to work (9.3 vs 5.7 weeks, p < 0.001). WC status was associated with greater 1-year residual disability and axial pain along with delayed return to work, without any difference in quality of life despite having fewer comorbidities and being a younger population. Further studies are needed to determine the societal impact that WC claims have on healthcare delivery in the setting of ACDF.

Poster 200: Earlier Evaluation by an Orthopaedic Surgeon Is Associated with Higher Return to Work Among Workers’ Compensation Patients Undergoing Shoulder Arthroscopy

Objectives: Workers’ compensation (WC) patients represent a large expenditure to the health care system and account for a large number of missed work days. Studies have shown that WC patients are less likely to return to work after injury or surgery. The purpose of our study was to determine if there was a higher return to full duty among WC patients who underwent arthroscopic shoulder surgery when they were seen by an orthopaedic surgeon within 100 days of injury. Methods: After obtaining Institutional Review Board approval, a retrospective chart review was conducted of WC patients treated with arthroscopic shoulder surgery by 2 senior authors at a community hospital between 2011 and 2018. WC patients that were treated with arthroscopic shoulder surgery were identified using Current Procedural Terminology (CPT) codes 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, and 29828. Patients were excluded if they were polytrauma patients who had undergone surgical procedures in other locations, patients who had a fracture, and patients being treated with revision shoulder surgery. A total of 59 WC patients were included in the study and were followed up to 2 years post-operatively. WC patients who identified as laborers were divided into 2 groups. The first group was evaluated by an orthopaedic surgeon within 100 days of injury (early orthopaedic evaluation) and the second group was evaluated by an orthopaedic surgeon more than 100 days after injury (late orthopaedic evaluation). The primary outcomes included the length of time from injury to evaluation by an orthopaedic surgeon and from surgery to return to work in some form. Results: Early orthopaedic evaluation was associated with a higher rate of return to full duty (p=0.02). The early orthopaedic evaluation group had a 69% (25 out of 36) return to full duty while the late orthopaedic evaluation group had a return to full duty of 39% (9 out of 23). There was no significant difference in the rate of return to work in some form with the early orthopaedic evaluation group returning at 94% (34 out of 36) and the late orthopaedic evaluation group returning at 83% (19 out of 23). There was a moderate association between time to evaluation by an orthopaedic surgeon following injury and time to return to work in some form (r=.22). There was no significant difference between the groups with respect to the type of laborer (p=.128). Conclusions: WC patients who were evaluated by an orthopaedic surgeon within 100 days of injury had a higher likelihood of return to full duty as well as return to work in some form compared to WC patients who were evaluated by an orthopaedic surgeon more than 100 days after injury. [Table: see text]

Do Outcomes Differ After Proximal Hamstring Repair for Patients Receiving Workers' Compensation?

Patients with workers' compensation (WC) insurance claims are often shown to experience inferior patient-reported outcomes (PROs) after an orthopaedic surgical intervention compared with patients without WC claims. To compare the postoperative PROs of patients with WC claims (WC patients) versus those without WC claims (non-WC patients) after proximal hamstring repair (PHR). Cohort study; Level of evidence, 3. WC patients who underwent PHR between November 2011 and to September 2020 were propensity score matched at a 1:2 ratio to non-WC patients according to age, sex, and body mass index. Comorbidity data were collected as well as minimum 1-year postoperative PRO scores for the Lower Extremity Functional Scale (LEFS), the Hip Outcome Score (HOS), and the 12-Item Short From Health Survey (SF-12) Physical Component Summary (PCS) and Mental Component Summary (MCS). The type of work was characterized according to national WC insurance guidelines as light (maximum 20 lbs [9.1 kg]), medium (maximum 50 lbs [22.7 kg]), or heavy (≥50 lbs) [>/=22.7 kg]. A total of 30 patients (10 WC and 20 non-WC) were included. The work type and baseline demographic characteristics of patients did not differ between groups. There were no significant between-group differences in postoperative PRO scores as measured by the LEFS (P = .488), HOS (P = .233), or SF-12 PCS (P = .521). However, the WC cohort showed inferior SF-12 MCS scores compared with the non-WC group (49.28 ± 9.97 vs 54.26 ± 9.69, respectively; P = .032). The WC status was also associated with an increased time needed for patients to return to full-duty work capacity (21 ± 9 vs 9 ± 8 weeks; P = .005). Our findings suggest that WC and non-WC patients who undergo PHR have comparable outcomes. Differences in SF-12 MCS scores and return to work time for full-duty capacity warrant further investigation.

Workers’ Compensation Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement Syndrome Experience Worse Mid-Term Outcomes but Similar Return-to-Work: A Propensity-Matched Analysis at 5-Year Follow-Up

To investigate mid-term patient-reported outcomes (PROs) and return-to-work for workers' compensation (WC) patients undergoing primary hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) versus propensity-matched, non-WC controls and to determine whether achievement rates of minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) differ between these populations. A retrospective cohort study was conducted on WC patients who underwent primary HA for FAIS from 2012 to 2017. WC and non-WC patients were propensity matched on a 1:4 basis by sex, age, and body mass index (BMI). PROs were compared preoperatively and at 5 years postoperatively, employing the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales, modified Harris Hip Score (mHHS), 12-item international Hip Outcome Tool (iHOT-12), and visual analog scales (VAS) for pain and satisfaction. MCID and PASS were calculated using published thresholds for these measures. Preoperative and postoperative radiographs and the presence and timing of return to unrestricted work were evaluated. Forty-three WC patients were successfully matched to 172 non-WC controls and followed for 64.2 ± 7.7 months. WC patients demonstrated lower preoperative scores for all measures (P≤.031) and worse HOS-ADL, HOS-SS, and VAS pain scores at 5-year follow-up (P ≤ .021). There were no differences in MCID achievement rates or magnitude of change between preoperative and 5-year postoperative PROs (P ≥ .093); however, WC patients achieved PASS at lower rates for HOS-ADL and HOS-SS (P ≤ .009). 76.7% of WC and 84.3% of non-WC patients returned to work without restrictions (P= .302) at 7.4 ± 4.4 versus 5.0 ± 3.8 months, respectively (P<.001). WC patients undergoing HA for FAIS report worse preoperative pain and function than non-WC patients and experience worse pain, function, and PASS achievement at 5-year follow-up. However, they demonstrate similar MCID achievement and magnitude improvement between preoperative and 5-year postoperative PROs, and return to work without restrictions at a similar rate to non-WC patients, although they may take longer to do so. Level III, retrospective cohort study.

The Influence of Workers' Compensation Status on Patient-Reported Outcomes after Cervical Disc Arthroplasty at an Ambulatory Surgical Center.

Workers' compensation (WC) status tends to negatively affect patient outcomes in spine surgery. This study aims to evaluate the potential effect of WC status on patient-reported outcomes (PROs) after cervical disc arthroplasty (CDR) at an ambulatory surgical center (ASC). A single-surgeon registry was retrospectively reviewed for patients who had undergone elective CDR at an ASC. Patients with missing insurance data were excluded. Propensity score-matched cohorts were generated by the presence or lack of WC status. PROs were collected preoperatively and at 6-week, 12-week, 6-month, and 1-year time points. PROs included the Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), visual analog scale (VAS) neck and arm pain, and Neck Disability Index. PROs were compared within and between groups. Minimum clinically important difference (MCID) achievement rates were compared between groups. Sixty-three patients were included, with 36 without WC (non-WC) and 27 with WC. The non-WC cohort demonstrated postoperative improvement in all PROs at all time points, with the exception of VAS arm past the 12-week point ( P ≤ 0.030, all). The WC cohort demonstrated postoperative improvement in VAS neck at 12-week, 6-month, and 1-year time points ( P ≤ 0.025, all). The WC cohort improved in VAS arm and Neck Disability Index at the 12-week and 1-year points as well ( P ≤ 0.029, all). The non-WC cohort reported superior PRO scores in every PRO at one or more postoperative time points ( P ≤ 0.046, all). The non-WC cohort demonstrated higher rates of minimum clinically important difference achievement in PROMIS-PF at 12 weeks ( P ≤ 0.024). Patients with WC status undergoing CDR at an ASC may report inferior pain, function, and disability outcomes compared with those with private or government-provided insurance. Perceived inferior disability in WC patients persisted into the long-term follow-up period (1 year). These findings may aid surgeons in setting realistic preoperative expectations with patients at risk of inferior outcomes.

Effect of workers' compensation status on pain, disability, quality of life, and return to work after lumbar spine surgery: a 1-year propensity-matched analysis.

Workers' compensation (WC) and litigation have been shown to adversely impact prognoses in a vast range of health conditions. Low-back pain is currently the most frequent reason for WC claims. The objective of this study was to conduct the largest propensity-matched comparison of outcomes between patients with WC and non-WC status who underwent lumbar spinal decompression with and without fusion. Complete data sets for patients who underwent 1- to 4-level lumbar spinal fusion or decompression alone were retrospectively retrieved from the Quality Outcomes Database (QOD), which included 1-year patient-reported outcomes from more than 200 hospital systems collected from 2012 to 2021. Population demographics, perioperative safety, facility utilization, patient satisfaction, disability, pain, EQ-5D quality of life, and return to work (RTW) rates were compared between cohorts for both subgroups. Statistical significance was set at p < 0.05. There were 29,652 patients included in the study. Laminectomy was performed in 16,939 with non-WC status and in 615 with WC, whereas fusion was performed in 11,767 with non-WC status and in 331 with WC. WC patients were more frequently male, a minority race, younger, less educated, more frequently a smoker, had a healthier American Society of Anesthesiologists grade, and with greater baseline visual analog scale (VAS) and Oswestry Disability Index (ODI) scores (p < 0.001). One-year postoperative improvements in VAS, ODI, quality-adjusted life years (QALYs), RTW rates, and satisfaction were all significantly worse for WC versus non-WC patients for both procedures. After adjusting for baseline differences via propensity matching, WC versus non-WC patients continued to demonstrate worse 3- and 12-month VAS and ODI scores, reduced 12-month QALY gain, and delayed RTW after both procedure types. WC status was associated with significantly greater residual disability and pain postoperatively, a lower quality of life, and delayed RTW. Utilizing resources to identify the negative influences on outcomes for WC patients may be valuable in preoperative optimization and could yield better outcomes in these patients.

Workers compensation patients experiencing depression report meaningful improvement in mental health scores after anterior cervical discectomy and fusion

BackgroundMental health has been demonstrated to affect postoperative outcomes. No prior literature has reported the relationship between preoperative mental health on outcomes following anterior cervical discectomy and fusion (ACDF) in the Workers Compensation (WC) population. MethodsWC claimants who underwent primary ACDF were identified from a single-surgeon retrospective database. Patients were separated by SF-12 MCS score into Depressed (<45.6) or Not Depressed (ND) (≥45.6) cohorts. Patient-reported Outcome Measurement Information System Physical Function (PROMIS PF), SF-12 Physical Component Score (SF-12 PCS), SF-12 MCS, visual analog scale (VAS) neck/arm pain, and Neck Disability Index (NDI) were collected and compared within and between groups. Minimum clinically important difference (MCID) achievement rates were compared between groups. ResultsDepressed patients had greater length of stay (p = 0.007) and postoperative narcotic consumption (p = 0.026). Depressed patients improved at 12-week to 2-year PROMIS PF, 6-month SF-12 PCS, 6-week to 6-month SF-12 MCS, 6-week to 6-month and 2-year VAS neck, all VAS arm, and 6-month NDI (p ≤ 0.045, all). ND patients improved at 12-week to 1-year PROMIS PF, 6-month to 2-year SF-12 PCS, 12-week to 1-year VAS neck, 6-week to 1-year VAS arm, and 12-week to 1-year NDI (p ≤ 0.044, all). Between groups, ND patients reported superior PROMIS PF, SF-12 MCS, VAS neck, VAS arm, and NDI scores at two or more periods (p ≤ 0.045, all). MCID achievement rate regarding SF-12 MCS was greater in the Depressed cohort at all postoperative points up to 1 year (p ≤ 0.020, all). ConclusionDepressed patients tended to have a greater length of stay and postoperative narcotic consumption immediately after surgery. Not depressed patients reported more favorable physical and mental function, pain, and disability scores preoperatively and postoperatively. Depressed patients reported greater MCID achievement in mental function following surgery. Depressed patients with WC have a greater likelihood of reporting tangible improvement in mental health scores following ACDF.

P137. Preliminary analysis on the influence of workers’ compensation status on outcomes of anterior lumbar interbody fusion at L5-S1

<h3>BACKGROUND CONTEXT</h3> Few studies have focused on outcomes among Workers' Compensation (WC) claimants undergoing anterior lumbar interbody fusion (ALIF). <h3>PURPOSE</h3> To determine the influence of WC on perioperative outcomes, patient-reported outcome measures (PROMs) and attainment rates of minimal clinically important difference (MCID) among patients undergoing single-level ALIF at L5S1. <h3>STUDY DESIGN/SETTING</h3> Retrospective. <h3>PATIENT SAMPLE</h3> A retrospective surgical database of an attending spine surgeon was utilized to identify patients with WC insurance undergoing single-level ALIF at L5S1. One-hundred and nine patients were included, with 82 in the non-WC and 27 in the WC cohort. <h3>OUTCOME MEASURES</h3> PROM data for visual analog scale (VAS) back/leg, Oswestry Disability Index (ODI), 12-Item Short Form (SF-12) Physical Composite Score (PCS) and Patient Reported Outcome Measurement Information System physical function (PROMIS-PF) was obtained preoperatively and at 6-weeks, 12-weeks, 6-months, 1-year and 2-years following ALIF. <h3>METHODS</h3> Patients were divided into groups based on insurance status: WC vs non-WC (including patients with private insurance or Medicare/Medicaid). Demographic and perioperative information was evaluated between insurance groups using student's t-test for independent samples for continuous variables and chi-squared test for categorical variables. Mean PROMs were compared with student's t-test for independent samples. Comparisons of preoperative and postoperative PROM values were evaluated with paired sample t-tests. Patients who achieved an improvement in PROM score greater than or equal to established threshold values were marked as achieving MCID. WC and non-WC groups were compared in MCID attainment rates across PROMs with chi-squared analyses. <h3>RESULTS</h3> A greater proportion of the non-WC cohort were Caucasian, while a significantly greater proportion of the WC cohort were African American and Hispanic (p=0.001). Significantly more patients in the WC cohort were smokers (p<0.001). Non-WC patients improved significantly from preoperative to postoperative timepoints of 6-months through 2-years for PROMIS-PF and SF-12 PCS, 6 weeks through 1 year for VAS back, 6 months/1 year for VAS leg and 12 weeks through 1-year for ODI (p≤0.048, all). WC patients improved significantly at postoperative timepoints for PROMIS-PF at 6 weeks (p=0.029), SF-12 PCS at 12 weeks (p=0.018), VAS back from 6 weeks to 6 months, and VAS leg at 6 months, only (p≤0.029, all). Mean VAS back scores were significantly greater in the WC cohort at 6 months and 1 year (p≤0.013, both), mean VAS leg scores were significantly greater in the WC cohort at 1 year (p=0.029), and mean ODI scores were significantly higher in the WC cohort at preoperative through 1 year (p≤0.040, all). With the exception of higher MCID achievement for VAS back at 12 weeks (p=0.037), no other differences in attainment rates were observed for any PROM at any time point or for the overall postoperative period. <h3>CONCLUSIONS</h3> Among patients receiving ALIF, WC insurance was more prevalent among patients identifying as Hispanic and African American, along with smokers. While physical function scores were similar between groups, long-term pain and disability (throughout the entire postoperative period) were significantly higher among patients with WC. MCID achievement, however, was largely comparable for all PROMs between WC and non-WC study groups. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Impact of Body Mass Index on Postsurgical Outcomes for Workers' Compensation Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion.

Increased morbidity associated with obesity imposes a greater financial burden on companies that provide insurance to their employees. Few studies have investigated the relationship between body mass index (BMI) and patient-reported outcome measures (PROMs) for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) in the workers' compensation (WC) population. WC patients who underwent a primary, single-level MIS TLIF were included/grouped according to BMI: nonobese (<30 kg/m2); obese I (≥30, <35 kg/m2); severe + morbid (≥35). PROMs were collected pre- and postoperatively: visual analog scale (VAS), Oswestry Disability Index (ODI), 12-Item Short Form (SF-12) physical composite score (PCS), and Patient-Reported Outcome Measurement Information System physical function (PROMIS-PF). BMI predictive power grouping on PROMs was evaluated using simple linear regression. Established minimum clinically important difference values were used to compute achievement rates across PROMs using logistic regression. A total of 116 nonobese, 70 obese I, and 61 severe + morbid patients were included. Demographics among BMI grouping significantly differed in gender, hypertensive status, and American Society of Anesthesiologists score (P ≤ 0.037, all). Operative time was significantly different in perioperative values among BMI grouping (P ≤ 0.001). Increased BMI was significantly associated with greater VAS back at 12 weeks and 2 years (P ≤ 0.026, all), greater ODI preoperatively at 12 weeks and 6 months (P ≤ 0.015, all), and decreased PROMIS-PF at 12 weeks (P ≤ 0.011, all). Mean PROMs between obese I and severe + morbid cohorts differed in SF-12 PCS at 12 weeks, only (P = 0.050). ODI overall was the only parameter for which minimum clinically important difference was achieved among BMI cohorts (P ≤ 0.023). WC patients with increased BMI were more likely to develop significant back pain and disability at numerous postoperative timepoints compared with nonobese individuals. Our findings highlight the weight management importance within WC population to minimize back pain and disability following MIS TLIF, but provide a sense of reassurance with comparable clinical improvement regardless of BMI. When considering the effect of weight, surgeons may incorporate these findings in managing patient expectations in the WC population undergoing lumbar spine surgery.

Obesity and Workers’ Compensation in the Setting of Minimally Invasive Lumbar Decompression

To investigate the influence of body mass index (BMI) on perioperative outcomes, postoperative patient-reported outcome measures (PROMs), and minimal clinically important difference (MCID) achievement among workers' compensation (WC) claimants undergoing minimally invasive lumbar decompression (MIS-LD). WC patients diagnosed with herniated nucleus pulposus undergoing single-level MIS-LD were identified. Patients were divided into 3 groups: Non-obese (<30 kg/m2), Obese I (≥30 and <35 kg/m2), and Obese II/III (≥35 kg/m2). PROMs were collected preoperatively and at 6 weeks, 12 weeks, 6 months, 1 year, and 2 years postoperatively. The predictive influence of BMI grouping on mean PROM scores was computed using simple linear regression. To compare PROMs between groups, post hoc pairwise comparisons of adjusted means were utilized. MCID achievement was compared between groups with χ2 analysis. A total of 81 patients were in the Non-obese cohort, and 43 and 45 in the Obese I and Obese II/III cohorts, respectively. Visual analog scale (VAS) leg, Oswestry Disability Index (ODI), and 12-Item Short Form Physical Composite Score (SF-12 PCS) were worse in the Obese I cohort at 12 weeks, and SF-12 PCS was lower in the Obese I vs. Obese II/III subgroup analysis (P ≤ 0.045, all). MCID achievement rates for ODI were higher for the Non-obese group at 12 weeks and overall (P ≤ 0.049, both). MCID attainment for VAS back was higher among the Non-obese cohort at 6-weeks (P= 0.022). Patients with higher levels of obesity were more likely to experience longer length of stay and delayed discharge following MIS-LD. Increasing BMI was generally not a significant predictor of postoperative pain, disability, or physical health PROMs at most timepoints. MCID achievement rates for disability relief were significantly higher for non-obese patients.

Workers’ Compensation Patients Improved After Hip Arthroscopy for Labral Tears: A 5-Year Outcome Propensity Score–Matched Study

Background: The workers’ compensation (WC) status has been associated with inferior outcomes in orthopaedic procedures and is usually excluded from clinical outcome studies. Therefore, comparative studies based on WC status are scarce. Purpose: (1) To determine outcomes of patients with WC claims treated with hip arthroscopy for labral tears at a minimum 5-year follow-up and (2) to compare these findings with a propensity score–matched control group without WC claims. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were propensity score matched to a control group without WC claims. Data were prospectively collected for all patients undergoing hip arthroscopy. Patients were included if they received primary hip arthroscopy for labral tears in the setting of femoroacetabular impingement, had a WC claim, and had preoperative and minimum 5-year follow-up patient-reported outcomes ([PROs]; modified Harris Hip Score [mHHS], Non-Arthritic Hip Score [NAHS], Hip Outcome Score–Sports Specific Subscale [HOS-SSS], and visual analog scale [VAS] for pain). Clinical outcomes were measured using the Patient Acceptable Symptom State (PASS), minimal clinically important difference (MCID), and maximum outcome improvement satisfaction threshold (MOI). Results: A total of 111 from 132 (84.1%) eligible WC patients met the inclusion criteria with an average follow-up time of 80.3 ± 37.3 months. WC cases demonstrated significant improvement from preoperatively to a minimum 5-year follow-up for mHHS, NAHS, HOS-SSS, and VAS for pain (P < .05). WC patients returned to work at a 66% rate, with an average clearance time of 4.7 months to light duty and 9.5 months to heavy duty. When compared with the control group, the WC group demonstrated lower pre- and postoperative PROs (P < .05); however, WC cases had a greater magnitude of improvement (ΔmHHS [P = .0012], ΔNAHS [P < .001], and ΔHOS-SSS [P = .012]). Rates of achieving MCID and MOI were similar in both groups (P > .05). The WC group went on to receive a future arthroscopy in 19 cases (17.1%), while 10 cases (4.5%) in the control group required revision arthroscopy (P < .001). Patients in both the WC and the control groups converted to total hip arthroplasty at similar rates (13.3% and 15.4%, respectively; P > .05). Conclusion: Patients with WC claims treated with hip arthroscopic surgery showed significant improvement and high rates of returning to work at a minimum 5-year follow-up. Although having lower scores in PROs and achieving PASS rates, no differences were found in MCID and MOI rates. Furthermore, WC patients had a greater magnitude of improvement from preoperatively to a minimum 5-year follow-up after hip arthroscopy. Therefore, even though more studies are needed to determine the causes of inconsistent outcomes in the WC population, hip arthroscopy can effectively treat labral tears in the setting of femoroacetabular impingement, regardless of the WC status.

Workers’ Compensation Status and Outcomes Following Lumbar Surgery

To determine the influence of preoperative workers' compensation (WC) status on patient-reported outcome measures following lumbar decompression with or without fusion. All patients undergoing lumbar decompression with or without fusion at a single academic institution between 2013 and 2017 were identified. Patients were split into groups based on WC status: no workers' compensation (NWC), WC), or retired. Intragroup analysis used paired t tests. Outcomes between groups were compared using Kruskal-Wallis H test. Multiple linear regression analysis determined if WC status was a predictor of change in patient-reported outcome measures. Subgroup analysis was conducted for WC patients who returned to work. Of 571 included patients, 242 (43.4%) had NWC, 83 (14.5%) had WC, and 246 (43.1%) were retired. Comparing within groups, WC patients showed significant improvement in Short Form-12 Health Survey Physical Component Score, Oswestry Disability Index, visual analog scale (VAS) back pain, and VAS leg pain (all P < 0.001) after surgery. However, WC patients improved less than NWC or retired patients in Short Form-12 Health Survey Physical Component Score (P= 0.010), VAS back pain (P= 0.028), and VAS leg pain (P= 0.015). WC was an independent predictor of decreased improvement in Short Form-12 Health Survey Physical Component Score (β=-4.31, P= 0.001), VAS back pain (β= 0.90, P= 0.034), and VAS leg pain (β= 1.50, P= 0.002) on multivariate analysis. WC patients who did not return to work was an independent predictor of decreased improvement in VAS back pain (β= 1.39, P= 0.016) and VAS leg pain (β= 2.11, P= 0.001). WC patients improve less than NWC patients. However, WC patients who return to work have similar VAS back and neck pain improvements as NWC patients.

Earlier Return to Light Duty Is Associated With Successful Return to Full Duty of Workers’ Compensation Patients Treated With Shoulder Arthroscopic Surgery

PurposeTo evaluate Workers’ Compensation (WC) patients who underwent arthroscopic shoulder surgery for workplace shoulder injuries and to determine whether there was an association between earlier return to light duty and earlier return to full duty.MethodsAfter receiving institutional review board approval, we performed a retrospective chart review of all WC patients treated with shoulder arthroscopic surgery by 2 senior authors between 2011 and 2018. The patients were divided into 2 groups: Group 1 went back to light-duty work within the first 100 days after surgery, whereas group 2 performed light-duty work after 100 days or performed no light-duty work. The primary outcomes included the length of time from surgery to light-duty work and the length of time from surgery to return to the full-duty work level.ResultsA total of 59 patients met the inclusion criteria. There was a moderate correlation between the number of days at which the patients were released to light duty and the days they were able to be released to full duty (r = 0.35). In group 1 (light duty ≤ 100 days), 18 patients (75%) went back to full duty, whereas only 16 patients (46%) in group 2 were able to return to full-duty work (P = .025).ConclusionsEarlier return to light duty is associated with earlier return to full duty after shoulder arthroscopic surgery in patients with a Workers’ Compensation claim. Additionally, WC patients who returned to early light duty in the first 100 days postoperatively had a higher rate of return to full duty than did patients who did not return to early light duty.Level of EvidenceLevel III, case-control study.