• Mohamed Macki, Sharath Kumar Anand, Travis Hamilton, Seokchun Lim, Tarek Mansour, Michael Bazydlo, Lonni Schultz, Muwaffak M Abdulhak, Jad G Khalil, Paul Park, Ilyas Aleem, Richard Easton, Jason M Schwalb, David Nerenz, and Victor Chang.
• Department of Neurosurgery.
• Spine. 2022 Jan 1; 47 (1): 495849-58.

Study DesignMichigan Spine Surgery Improvement Collaborative (MSSIC) prospectively collects data on all patients undergoing operations for degenerative and/or deformity indications.ObjectiveWe aimed to identify which factors are significantly associated with return-to-work after lumbar surgery at long-term follow-up.Summary Of Background DataPrior publications have created a clinically relevant predictive model for return-to-work, wherein education, gender, race, comorbidities, and preoperative symptoms increased likelihood of return-to-work at 3 months after lumbar surgery. We sought to determine if these trends 1) persisted at 1 year and 2 years postoperatively; or 2) differed among preoperatively employed versus unemployed patients.MethodsMSSIC was queried for all patients undergoing lumbar operations (2014-2019). All patients intended to return-to-work postoperatively. Patients were followed for up to 2 years postoperatively. Measures of association were calculated with multivariable generalized estimating equations.ResultsReturn-to-work increased from 63% (3542/5591) at 90 days postoperatively to 75% (3143/4147) at 1 year and 74% (2133/2866) at 2 years postoperatively. Following generalized estimating equations, neither clinical nor surgical variables predicted return-to-work at all three time intervals: 90 days, 1 year, and 2 years postoperatively. Only socioeconomic factors reached statistical significance at all follow-up points. Preoperative employment followed by insurance status had the greatest associations with return-to-work. In a subanalysis of patients who were preoperatively employed, insurance was the only factor with significant associations with return-to-work at all three follow-up intervals. The return-to-work rates among unemployed patients at baseline increased from 29% (455/1100) at 90 days, 44% (495/608) at 1 year, and 46% (366/426) at 2 years postoperatively. The only two significant factors associated with return-to-work at all three follow-up intervals were Medicaid, as compared with private insurance, and male gender.ConclusionIn patients inquiring about long-term return-to-work after lumbar surgery, insurance status represents the important determinant of employment status.Level of Evidence: 2.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

9 keywords...

hide…