Workers' Compensation Population Research Articles

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.

Differences in BMI obesity measures in a workers compensation population: a cross-sectional study.

The agreement between BMI and DEXA %BF was assessed by the Pearson correlation coefficient among 1394 evaluable patients over a 5-year period. Sensitivity and specificity were calculated to measure how well BMI can identify true obese and nonobese individuals. Using at least 30kg/m2 to identify obesity, BNI had a specificity of 0.658 and a sensitivity of 0.735. The correlation was better in females at 0.66, compared to males at 0.55, and weaker in older age groups at 0.42, as compared to the youngest age group at 0.59. Overall, 29.8% of the population was reclassified based on their DEXA %BF measures. In a 5-year cohort worker compensation population, BMI was an inaccurate measure of true obesity.

Impact of Ambulatory Setting for Workers’ Compensation Patients Undergoing One-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion and Review of the Literature

To compare perioperative characteristics and patient-reported outcome measures (PROMs) in workers' compensation (WC) patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in either the inpatient/outpatient setting. Patients with WC undergoing 1-level MIS-TLIF were included. Patients were separated into inpatient/outpatient groups and demographically propensity score matched. PROMs included visual analog scale (VAS) back/VAS leg/Oswestry Disability Index (ODI)/12-item Short Form Physical Composite Score (SF-12 PCS)/Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) preoperatively and 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. Results were compared preoperatively and postoperatively and between cohorts. Minimum clinically important difference (MCID) achievement was determined through comparison with values established in the literature. A total of 216 patients were included (184 inpatient). The inpatient cohort (IC) showed worse perioperative outcomes in multiple measures (P < 0.034; all). The IC improved in all PROMs (P < 0.038; all), besides ODI at 6 weeks, SF-12 PCS at 6 weeks/6 months/1 year, and PROMIS-PF at 6 weeks. The outpatient cohort (OC) improved in VAS back at all time points and VAS leg at 6 months (P < 0.033; all). Between cohorts, the OC showed better scores with VAS leg/ODI/SF-12 PCS/PROMIS-PF at multiple time points (P < 0.031; all). Most of the IC achieved MCID, aside from ODI, whereas the OC achieved MCID in SF-12 PCS. MCID achievement between cohorts was higher in the IC at PROMIS-PF at 1 year and VAS back overall (P < 0.034; all). Despite more comorbidities and worse perioperative measures, the IC showed improved PROMs from preoperative to ≥1 follow-up visit, whereas the OC had improvement with only VAS back and leg. The IC showed multiple MCID achievements, whereas the OC showed MCID in only SF-12 PCS. These findings may help guide a surgeon's decision making between inpatient/outpatient lumbar surgery in the WC population.

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.

Evaluation of Factors Affecting Return to Work Following Carpal Tunnel Release: A Statewide Cohort Study of Workers' Compensation Subjects

Most randomized trials comparing open carpal tunnel release (OCTR) to endoscopic carpal tunnel release (ECTR) are not specific to a working population and focus mainly on how surgical technique has an impact on outcomes. This study's primary goal was to evaluate factors affecting days out of work (DOOW) following carpal tunnel release (CTR) in a working population and to evaluate for differences in medical costs, indemnity payments, disability ratings, and opioid use between OCTR and ECTR with the intent of determining whether one or the other surgical method was a determining factor. Using the Ohio Bureau of Workers' Compensation claims database, individuals were identified who underwent unilateral isolated CTR between 1993 and 2018. We excluded those who were on total disability, who underwent additional surgery within 6 months of their index CTR, including contralateral or revision CTR, and those not working during the same month as their index CTR. Outcomes were evaluated at 6 months after surgery. Multivariable linear regression was performed to evaluate covariates associated with DOOW. Of the 4596 included participants, 569 (12.4%) and 4027 (87.6%) underwent ECTR and OCTR, respectively. Mean DOOW were 58.4 for participants undergoing OCTR and 56.6 for those undergoing ECTR. Carpal tunnel release technique was not predictive of DOOW. Net medical costs were 20.7% higher for those undergoing ECTR. Multivariable linear regression demonstrated the following significant predictors of higher DOOW: preoperative opioid use, legal representation, labor-intensive occupation, increasing lag time from injury to filing of a worker's compensation claim, and female sex. Being married, higher income community, and working in the public sector were associated with fewer DOOW. In a large statewide worker's compensation population, demographic, occupational, psychosocial, and litigatory factors have a significant impact on DOOW following CTR, whereas differences in surgical technique between ECTR and OCTR did not. Therapeutic III.

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.

Time to Surgery Affects Return to Work Rates for Workers' Compensation Patients With Single-Level Lumbar Disk Herniation.

The optimal timing of lumbar diskectomy in patients with lumbar disk herniation and radiculopathy has not been studied in the workers' compensation (WC) population. A total of 10,592 patients received lost-work compensation from the Ohio Bureau of Workers' Compensation for a lumbar disk herniation between 2005 and 2012. The primary outcome was whether subjects return to work (RTW). To determine the impact time to surgery had on RTW status, the authors performed a multivariate logistic regression analysis. They compared other secondary outcomes using chi-square and t tests. The authors identified 1287 WC patients with single-level disk herniation and radiculopathy. Average time from injury to surgery was 364 days (range, 2-2710 days). The WC patients with shorter duration of radiculopathy before diskectomy had higher RTW rates; fewer physical therapy, chiropractic, and psychotherapy sessions; and fewer postoperative diagnoses of psychological illnesses (P<.05). A multivariate logistic regression model showed that time to surgery was an independent, negative predictor of RTW (odds ratio [OR], 0.97 per month; P<.01). Legal representation (OR, 0.56; P<.01), psychological comorbidity (OR, 0.32; P=.01), and mean household income (OR, 1.01 per $1000; P<.01) also significantly affected RTW status. These results confirm that the duration of radiculopathy due to single-level lumbar disk herniation has a predictive value for the WC population undergoing diskectomy. Within 12 weeks of injury, post-diskectomy patients do reasonably well, with 70.0% of subjects returning to work. [Orthopedics. 2021;44(1):e43-e49.].

Subsequent Pain or Injury After Foot and Ankle Surgery in Patients Receiving Workers’ Compensation

Workers' compensation (WC) has been associated with poor outcomes following a variety of injuries and surgeries, but rates of subsequent pain or injury (SPI) following surgery have not been studied. The purpose of this study was to investigate the rates, locations, and risk factors of SPI in WC patients and non-WC patients who underwent the same surgeries. With institutional review board approval, records from foot or ankle surgery performed by author P.P. from 2009 to 2015 were obtained. A retrospective chart review was performed on all WC and non-WC patients with at least 1 Current Procedural Terminology code of interest. SPI was defined as a new injury at a different anatomical location occurring 2 months to 2 years after the index surgery. Chi-square and 2-tailed t tests were used to compare risk factors and rates of SPI in both groups. The WC population had higher rates of SPI than the non-WC population. Specifically, 13 of 56 WC patients (23.2%) vs 12 of 165 non-WC patients (7.3%) reported SPI (P = .001). The hip, knee, and contralateral foot and ankle were common areas of SPI in both groups. Legal representation and increased age were risk factors for SPI in the WC population. Specifically, 10 of 13 WC patients with SPI had legal representation vs 16 of 43 WC patients without SPI (P = .02). Female sex was a risk factor for SPI in the non-WC population. WC patients had higher rates of subsequent pain or injury than non-WC patients. Legal representation was a risk factor for SPI in the WC population. Level III, comparative series.

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

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.

Subsequent Injury is Common after Foot and Ankle Surgery in Patients Receiving Workers’ Compensation

Category: Ankle Introduction/Purpose: Workers’ compensation (WC) has been associated with poor outcomes following a variety of injuries and surgeries. Previous studies have investigated surgical outcomes via satisfaction surveys, but rates of subsequent injury following surgery have not been specifically studied. The purpose of this study was to investigate the rates, locations and risk factors for subsequent injuries in WC patients and non-WC patients who underwent the same surgeries. Methods: With IRB approval, we identified the records of patients with a foot or ankle surgery performed by a single surgeon from 2009-2015. We included only surgeries with one of the most common current procedural terminology (CPT) codes from the WC population. A retrospective chart review was performed on all WC and non-WC patients with at least one of these CPT codes. A subsequent injury was defined as a new injury at a different anatomical location that occurred from 2 months to 2 years after the index surgery. Chi-square and two-tailed t-tests were used to compare WC and non-WC patient populations, and to determine factors associated with subsequent injuries. Results: Overall, the WC population had higher rates of subsequent injury than the non-WC population 23.21% versus 7.27%, p=.0011. Within the WC patient population, patients with subsequent injuries were older than patients without subsequent injuries 48.78±7.30 versus 41.58±12.40, p=.0137. In a blinded review of the charts and Iowa Courts Online, legal representation was found to be more common in WC patients with subsequent injuries than WC patients without subsequent injuries (76.92% versus 37.21%, p=.0240). In the non-WC population, there were more males in the group without subsequent injuries than in the group with subsequent injuries 42.48% versus 8.33%, p=.0287. There were no significant differences in locations of subsequent injury. Hip, knee and contralateral foot and ankle were common areas of subsequent injury in both groups. Conclusion: Overall, WC patients had higher rates of subsequent injury than non-WC patients. Within the WC group, legal representation further raised the risk of subsequent injury. Gender may mediate variable reporting of subsequent injuries in non-WC populations. While the reason for this increased risk of subsequent injury is not known, the differences are enough that they should be considered when counseling WC patients considering these surgeries. Additionally, if further study supported these findings, knowledge of the areas at risk for subsequent injury might lead to preventative strategies that could decrease the risk of subsequent injury.

The Timing of Surgery Affects Return to Work Rates in Patients With Degenerative Lumbar Stenosis in a Workers' Compensation Setting.

Retrospective Cohort Study. The objective of this study is to determine how time to surgery affects outcomes for degenerative lumbar stenosis (DLS) in a workers' compensation (WC) setting. WC subjects are known to be a clinically distinct population with variable outcomes following lumbar surgery. No study has examined the effect of time to surgery in this clinically distinct population. A total of 227 Ohio WC subjects were identified who underwent primary decompression for DLS between 1993 and 2013. We allocated patients into 2 groups: those that received operative decompression before and after 1 year of symptom onset. Our primary outcome was, if patients were able to make a stable return to work (RTW). The authors classified subjects as RTW if they returned within 2 years after surgery and remained working for >6 months. The early cohort had a significantly higher RTW rate [50% (25/50) vs. 30% (53/117); P=0.01]. A logistic regression was performed to identify independent variables that predicted RTW status. Our regression model showed that time to surgery remained a significant negative predictor of RTW status (P=0.04; odds ratio, 0.48; 95% confidence interval, 0.23-0.91). Patients within the early surgery cohort cost on average, $37,332 less in total medical costs than those who opted for surgery after 1 year (P=0.01). Furthermore, total medical costs accrued over 3 years after index surgery was on average, $13,299 less when patients received their operation within 1 year after symptom onset (P=0.01). Overall, time to surgery had a significant impact on clinical outcomes in WC subjects receiving lumbar decompression for DLS. Patients who received their operation within 1 year had a higher RTW rate, lower medical costs, and lower costs accrued over 3 years after index surgery. The results presented can perhaps be used to guide surgical decision-making and provide predictive value for the WC population.

Treatment of Recurrent Lumbar Disc Herniation With or Without Fusion in Workers' Compensation Subjects.

Retrospective cohort study. To determine outcomes after reoperation discectomy with or without fusion surgery for recurrent lumbar disc herniation (RLDH) in the workers' compensation (WC) population. RLDH is estimated to occur in 7% to 24% of patients after discectomy. There are two main surgical options after reherniation: a revision discectomy (RD), or an RD combined with fusion (RDF). A total of 10,592 patients received lost-work compensation from the Ohio Bureau of Workers' Compensation for a lumbar disc herniation between 2005 and 2012. Patients with lumbar spine comorbidities, a smoking history, or multilevel surgery were excluded. One hundred two patients had RD alone for RLDH and 196 had RDF procedures. The primary outcome was whether subjects returned to work (RTW). A total of 298 WC patients met our study criteria, including 230 (77.2%) men and 68 (22.8%) women with an average age of 39.4 years (range 19-66). The RDF group had lower rates of RTW than the RD group (27.0% vs 40.2%; P = 0.03). Multivariate regression analysis showed that reoperation with discectomy and fusion (P = 0.04; odds ratio [OR] = 0.56), psychiatric illness (P < 0.01; OR = 0.19), and opioid analgesic use within 1 month of reoperation (P < 0.01; OR = 0.44) were independent negative predictors of RTW. RDF patients were supplied with opioids for 252.3 days longer (P < 0.01) and incurred $34,914 (31.8%) higher medical costs (P < 0.01) than the RD alone group. We analyzed outcomes after operative management of RLDH in the WC population. WC patients receiving RDF had lower RTW rates, higher costs, and a longer duration of postoperative opioid use than those receiving RD alone. This information allows for informed patient management decisions and suggests that fusion should be reserved for patients with clear indications for its use. We are unable to conclude what treatment method is best, but rather we provide a baseline for future studies. 3.

Vertebroplasty and Return to Work for Thoracolumbar Fractures Within the Workers' Compensation Population.

Retrospective cohort study. Analyze efficacy of vertebroplasty and its affect on return to work (RTW) in a workers' compensation (WC) population SUMMARY OF BACKGROUND DATA.: Vertebroplasty remains a controversial treatment modality for vertebral compression fractures (VCFs). No studies have analyzed use of vertebroplasty in the clinically distinct WC population. A total of 371 Ohio WC subjects were identified who sustained VCFs and were treated with either vertebroplasty or conservative medical therapy between 1993 and 2013 using Current Procedural Terminology procedural and International Classification of Diseases, Ninth Revision diagnosis codes. Subjects with a prior smoking history, prior thoracolumbar surgery or comorbidities, or underwent decompression and/or fusion within 3 months after injury were excluded. Forty-six subjects had undergone vertebroplasty within 1 year of injury and were therefore included in the vertebroplasty group. The remaining 325 subjects received spinal orthosis and formed the control group. The primary outcomes were whether subjects returned to work at early and late time points. Early RTW was defined as returning to work within 3 months and remaining at work for more than 6 months of the following year. Late RTW was defined as returning to work within 2 years and remaining at work for more than 6 months of the following year. Secondary outcomes included opioid use, all-cause mortality, and additional VCFs. Approximately 37% (17/46) of vertebroplasty group made an early RTW, compared with 35.4% (115/325) of control group (P = 0.835). Regarding late RTW, only 54.3% (25/46) of vertebroplasty group made a sustainable RTW, compared with 70.8% (230/325) of subjects in control group (P = 0.025). In addition, the vertebroplasty group was associated with significantly higher postoperative opioid use. Vertebroplasty may not be an effective treatment modality for VCFs in the WC population when RTW is the primary goal. 3.

How expensive is the decision to suture a meniscal tear? Surgical and monetary concerns in a workers’ compensation population

The cost of meniscal sutures and the rate of failure are important concerns in a worker's compensation population. Hypothesis We prospectively analysed our cohort of workers’ compensation patients operated to a meniscal tear in a two years’ period (2013 and 2014) to test two hypothesis: patients submitted to a meniscus suture stay out of work for a longer period of time–monetary compensation is smaller in patients with the sutured meniscus. Material and methods We prospectively analysed a sample of 51 consecutive patients, under 45 years, submitted to either a meniscal suture or a partial meniscectomy (minimum follow-up of 12 months). The exclusion criteria where unstable knees, relevant cartilage lesion (outerbridge grade > = III) and any concomitant surgical procedures (like ligament reconstruction). The patients were analysed using this criteria: cost of surgery (in euros) –sick leave period, permanent disability (measured in percentage) which will lead to monetary compensation, pre and postoperative Lysholm and IKDC scores. Results There were 51 patients consecutively operated due to a meniscal tear who met the inclusion criteria. The patients were divided in–Group A–31 patients submitted to partial meniscectomy, Group B–20 patients submitted to meniscal suture The follow-up was similar between groups–group A (average 21, 8 months; min 15, max 28) group B (average 20,3 months; min 12, max 47). In Group A (meniscectomy) the direct cost of the surgery was 1373,8€ (min 1241,52; max 1584,2). Clinical preoperative scores–Lysholm–average 14,9; min 1; max 57.–IKDC–average 20,8; min 5,7; max 47,1. Final postoperative scores - Lysholm- average 63,2; min 16; max 92.–IKDC–average 61,7; min 12,6; max 97,7. Overall 90,3% were satisfied with the treatment result. Permanent disability–8,94% (SD37) The sick leave period was 152,13 (average, with 72,7SD) In Group B, (meniscal suture) the direct cost of the surgery was 1979,8,8€ (min 2462,4; max 4080). Clinical preoperative scores–Lysholm–average 15,7; min 0; max 30.–IKDC–average 21,1; min 8; max 65,5. Final postoperative scores–Lysholm average 88,7; min 70; max 100.–IKDC (at discharge) –average 86; min 34,5; max 100. All patients were satisfied with the treatment result. Permanent disability–1,65% (SD 1,98) The sick leave period was 228,75 (average, with 327 SD). Conclusion The cost of surgery is significantly higher in the suture group ( P P

Preoperative Duration of Opioid Use and Return to Work (RTW) Rates after Single-Level Cervical Fusion in Workers’ Compensation (WC) Setting

Workers receiving compensation from Bureau of Workers’ Compensation (BWC) are considered high risk population for work-related musculoskeletal disorders. Many studies have shown that this group has poor functional outcomes much worse than general population. In the WC population, spinal surgical procedures plus opioid use are associated with drastic increase in medical costs. The use of opioid medications is an independent risk factor for the catastrophic medical costs.

Pedicle screws vs minimally invasive posterior-lumbar-interbody-fusion with spinous process fixation in the workers compensation population: early outcomes with minimum one year follow up

Journal of the American College of Surgeons: October 2014 - Volume 219 - Issue 4 - p e123-e124 doi: 10.1016/j.jamcollsurg.2014.07.716

Hip Arthroscopy for Labral Tears in Workers’ Compensation

Background: Workers’ compensation (WC) status has been related to clinical outcomes; however, no comparative studies have been performed to assess 2-year outcomes between hip arthroscopy patients based on WC status. Purpose: To evaluate 2-year outcomes of patients receiving WC who underwent hip arthroscopy for labral tears and to compare outcomes with those of a matched control group not receiving WC. Study Design: Cohort study; Level of evidence, 3. Methods: During the study period between June 2008 and August 2010, data were collected on all patients treated with hip arthroscopy. Inclusion criteria for the study group were diagnosis of labral tear and WC status. All patients were assessed pre- and postoperatively with 4 patient-reported outcome (PRO) measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), and Hip Outcome Score–Sport-Specific Subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS), and satisfaction was measured on a scale from 0 to 10. A matched-pair group of patients not associated with WC was selected in a 1:1 ratio according to age within 3 years, sex, surgical procedures, and radiographic findings. Results: Twenty-one hips were included in each group. Patients with WC status had significantly lower preoperative PRO scores for all measures (P < .001). However, there was no significant difference between VAS pain scores between the groups. Of the WC patients, 86% returned to work at a median 82 days postoperatively. For the WC group, the score improvement from preoperative to 2-year follow-up was 46 to 67.7 for mHHS, 39.3 to 66 for NAHS, 39.7 to 69.5 for HOS-ADL, and 15.3 to 49.8 for HOS-SSS. For the control group, the score improvement from preoperative to 2-year follow-up was 67.9 to 85.8 for mHHS, 62.6 to 84.4 for NAHS, 69.8 to 86.9 for HOS-ADL, and 41.9 to 73.8 for HOS-SSS. Both groups demonstrated statistically significant postoperative improvement in all scores, and the average amount of change of preoperative to postoperative scores between the 2 groups was only significantly different for the HOS-ADL in the control group (P = .043). However, the WC group demonstrated greater improvement in aggregate scores in the HOS-ADL. Pain scores decreased from 7 to 3.9 in the WC group and 5.8 to 3.2 in the control group and were not significantly different between the groups. Patient satisfaction was 6.8 for the WC group and 7.7 for the control group, with no significant difference between groups. Conclusion: Our study demonstrated that WC patients had significantly lower baseline PRO scores when compared with a matched-pair control group. However, both groups demonstrated statistically significant postoperative improvement in all scores. Patients with WC status started and ended with lower absolute scores but benefited from arthroscopic intervention for hip injuries. While patient and physician expectations may be adjusted accordingly, these results may reflect favorably on the use of hip arthroscopy for labral tears in the WC population.

A Comparison of Perioperative Costs and Outcomes in Patients With and Without Workers’ Compensation Claims Treated With Minimally Invasive or Open Transforaminal Lumbar Interbody Fusion

A nonrandomized, nonblinded prospective review. To analyze intraoperative, immediate postoperative, and financial outcomes in worker's compensation (WC) and non-WC patients undergoing either an open or a minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF). Few studies have analyzed outcomes in a WC population of MIS TLIFs. A total of 66 consecutive patients undergoing a single-level TLIF (open/MIS) were analyzed (33 open and 33 MIS). Twenty-four total WC patients were identified (11 MIS and 13 open). Patients in either cohort (MIS/open) were matched according to insurance status (WC) and medical comorbidities (Charleston disability index). Every patient in this study had a diagnosis of either degenerative disc disease or spondylolisthesis and stenosis. Operative time (min), length of stay (d), estimated blood loss (mL), anesthesia time (min), visual analogue scale scores, and hospital cost/payment amount were assessed (MIS/open and work-comp versus non-work comp). There were no statistically significant differences between MIS WC and non-WC TLIFs with respect to surgical time, length of stay, estimated blood loss, visual analogue scale scores, and anesthesia time. There were no statistically significant differences between open WC and non-WC TLIF patients in all of the same above-mentioned parameters. There were significant differences between MIS (WC and non-WC) and open (WC and non-WC) TLIFs in clinical outcomes. There were statistically significant differences in total costs amounts between WC MIS TLIF and WC open TLIF ($28,060 vs. $33,862, respectively; P = 0.0311) and non-WC MIS TLIF versus non-WC open TLIF groups ($29,429 vs. $32,998, respectively; P = 0.0001). Contrary to popular belief, immediate outcomes and hospitalizations between non-WC and WC populations did not differ regardless of surgical technique (MIS/open). Differences occurred in improved outcomes with an MIS TLIF versus an open TLIF even in a WC environment. MIS TLIF WC and non-WC patient hospital costs were lower than their open TLIF counterparts.

Psychological profile and work status of a predominantly Hispanic worker's compensation population with chronic limb pain.

The purposes of this study were to describe the psychosocial profile and to measure function (posttreatment work status) after surgical and non-surgical treatment in a predominantly Hispanic worker's compensation population with chronic limb pain. We conducted an archival review of records from 91 patients treated for neuropathic pain in a specialty clinic over a 10-year period who had extreme difficulty accepting or managing pain. Medical records from individuals with proven nerve dysfunction experiencing pain >3 months and whose record contained a full psychological evaluation were included. All patients received patient-centered care, a prescription to return to work, periodic pain assessment, and clinical evaluation of sensory and motor function plus pharmacologic pain management. Surgery was determined by the degree of sensory-motor abnormalities in the absence of untreated psychological distress regardless of pain level or worker's compensation status. The majority of patients returned to work after treatment of nerve injury. No differences were noted between surgical/non-surgical treatment groups on initial pain level (p = 0.2), litigation status (p > 0.5), and posttreatment work status (p > 0.05). However, individuals expecting surgery also expected total relief of pain with surgical intervention. Psychosocial assessment, support, and adequate pain treatment seem to mediate the ability of an individual with chronic limb pain to return to work regardless of surgical/non-surgical treatment. Patients' expectations of surgery may be unrealistic and are best addressed prior to treatment.