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Predictors of Return to Work after Lumbar Fusion for Degenerative Disc Disease in Workers' Compensation Subjects
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NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S251–S337
RESULTS: Two hundred fifty-eight patients were included (NR=208, RI=38, RC=12). Mean time to re-operation (n=50) was 496 days. Rod fractures (15) and PJK (9) were the most common indications for revisions. For RC patients, hardware failure (3) and sagittal imbalance (4) were the most prevalent re-operation drivers. All patients improved in all HRQL at 2-years compared to baseline (p<.05) except for MCS in the RI group, and MCS, SRS Ac and SRS Ment for RC patients (p>.05). Scores between NR and RI groups were different at each time in ODI, MCS, PCS, SRS Ac, SRS Pa and SRS Tot (p<.05); RC group had worse ODI, SRS Ac, SRS Pa and SRS Tot compared to NR at all times (p<.05); RC-S1 and RC-R1 displayed similar raw HRQL scores at all follow-up and overall. Normalized IHS HRQL for RI were worse for PCS, SRS Ac and SRS App compared to NR (p<.05), indicating less improvement during 2-year recovery period. RC-R1 IHS were significantly worse than RI in MCS, SRS Ment, SRS Satis and SRS Tot (p<.05). CONCLUSIONS: ASD patients indicated for revisions for radiographic and implant-related complications differ significantly in their overall 2-year recovery process compared to primary patients, using a normalized IHS method for determining HRQL changes. Traditional methods analyzing revision patients’ recovery kinetics may overestimate their improvements. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.492
P167. The Influence of Sub-Diagnosis on Radiographic and Clinical Outcomes after Lumbar Fusion for Degenerative Disc Disorders: a 15-Year Meta-Analysis Amandeep Bhalla, MD1, Andrew J. Schoenfeld, MD2, Jaiben George, MD3, Christopher M. Bono, MD2; 1Long Beach, CA, USA; 2 Brigham and Women’s Hospital, Boston, MA, USA; 3Cleveland Clinic, Cleveland, OH, USA BACKGROUND CONTEXT: There is a large body of literature describing lumbar fusion surgery and associated clinical and radiographic outcomes for degenerative disc diseases, considered together as a broad category. However, there is scant discussion in the literature of how outcomes for lumbar fusion are influenced by preoperative diagnosis. PURPOSE: By performing a 15-year meta-analysis, the authors sought to better understand the relationship between preoperative diagnosis and outcomes for lumbar fusion surgery. STUDY DESIGN/SETTING: Meta-analysis. PATIENT SAMPLE: Adult patients undergoing spinal fusion surgery for degenerative disc disorders of the lumbar spine. OUTCOME MEASURES: VAS scores, complication rates, & fusion rates were measured and stratified by preoperative diagnosis. METHODS: With adherence to the PRISMA guidelines for meta-analysis, electronic searches were performed through PubMed, Scopus, and Web of Science to gather all studies involving lumbar fusion for degenerative disc disorders from January 2000 to August 2014. A detailed analysis of papers yielded by the query was performed. Disorders occurring at various points along the degenerative cascade were included, namely, degenerative spondylolisthesis (DDDsp), adult degenerative scoliosis (DDDsc), painful, dynamically unstable, degenerative disc disease (DDDu) (excluding spondylolisthesis), and degenerative disc disease not specified as stable or unstable (DDDn). Exclusion criteria included revision surgeries and the diagnosis of isthmic spondylolisthesis or spinal stenosis alone. Abstracted information included diagnosis, fusion technique, study design, number of levels fused, length of follow up, complication rate, and validated outcome measures. RESULTS: One hundred articles met inclusion criteria and yielded data for 8,706 patients. There was 91.7% agreement between reviewers on inclusion of abstracts for the study. This results in a Cohen’s kappa=0.49. The most common diagnosis was DDDn (44%), followed by DDDsp (43%), DDDsc (11%), and DDDu (2%). The mean clinical improvement in VAS scores was significantly different among the diagnoses (p<.001) with DDDsp demonstrating the highest improvement (60%) and DDDns having the lowest
(45%). Complication rates also differed significantly based on the diagnosis (p<.001), with highest rate seen in the DDDsc group (18%), followed by DDDsp (14%), DDDn (12%), and DDDu (7%). There was not a significant difference in the fusion rates by preoperative diagnosis. CONCLUSIONS: The preoperative diagnosis of degenerative spondylolisthesis showed a statistically significant clinical benefit from lumbar fusion compared to other diagnoses. The senior author (CB) performed a similar analysis of the literature over a 20-year period (1979–2000), and published findings indicative of a relationship between preoperative diagnosis and outcomes (Bono & Lee, 2005). The prior study, as well as this one, shows DDDsc to have the highest complication rate. Over the past 15 years, when compared to the prior 20 years, there is greater success in achieving bony fusion, regardless of preoperative diagnosis. This information may be helpful in discussing anticipated outcomes of lumbar fusion surgery for patients with lumbar degenerative disc disorders. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.493
P168. Predictors of Return to Work after Lumbar Fusion for Degenerative Disc Disease in Workers’ Compensation Subjects Joshua T. Anderson1, Erik Tye, BA2, Arnold Haas, BS3, Nicholas U. Ahn, MD4; 1Cleveland Heights, OH, USA; 2Case Western Reserve University School of Medicine, Cleveland, OH, USA; 3Ohio Bureau of Worker’s Compensation, Columbus, OH, USA; 4University Hospital of Cleveland, Department of Orthopedic Surgery, Cleveland, OH, USA BACKGROUND CONTEXT: Lumbar fusion for the indication of degenerative disk disease (DDD) and diskogenic low back pain is associated with variable clinical outcomes. In addition, US patients with workers’ compensation (WC) claims often have worse fusion outcomes than the general population. Few studies have evaluated the risk factors for poor outcomes within this clinically distinct population. PURPOSE: The purpose of the study was to identify preoperative factors that predicted return to work (RTW) status after diskogenic lumbar fusion in patients with workers’ compensation claims. STUDY DESIGN/SETTING: Retrospective cohort study of a workers’ compensation population. PATIENT SAMPLE: Two hundred forty-one subjects met our RTW criteria. The remaining 796 formed the out of work (OOW) group. OUTCOME MEASURES: The primary outcome measure of this study was whether subjects met the authors’ criteria for return to work. Secondary outcomes within 3 years after index fusion included: days out of work, medical costs paid by the Ohio Bureau of WC, opioid analgesic use, use of physical therapy and chiropractic care, rates of new psychiatric comorbidity, development of failed back syndrome, pseudoarthrosis, newly awarded permanent disability benefits, all-cause mortality and revision surgery. METHODS: The authors used International Classification of Diseases, Ninth Revision (ICD-9), diagnosis and Current Procedural Terminology (CPT) procedural codes to identify 1,037 subjects from the Ohio Bureau of WC database who underwent fusion for DDD between 1993 and 2013 with at least 3 years of follow-up. To identify preoperative predictors of postoperative return to work status, the authors used multivariate logistic regression analysis, adjusting for many important covariates. RESULTS: Significant negative preoperative predictors of RTW status included: being out of work for greater than 1 year (p<.001; odds ratio [OR], 0.24), psychiatric history (p<.001; OR 0.14), male sex (p=.014; OR 0.65), prolonged use of opioid analgesics greater than 1 year (p<.001; OR 0.46), and legal representation (p=.042; OR 0.67). The return to work rates associated with these risk factors were 10.4%, 2.0%, 21.1%, 11.9%, and 20.7% respectively. Of the study subjects, 76.8% (n=796) did not return to work and had considerably worse postoperative outcomes, highlighted by chronic opioid dependence, high rates of failed back syndrome, additional surgery, and new psychiatric comorbidity.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S251–S337
S325
CONCLUSIONS: This study identified a number of significant predictors for worse return to work outcomes within a large population of subjects with workers’ compensation claims. Psychiatric disorders, legal representation, extensive work loss, and prolonged opioid use before fusion negatively affected the likelihood of returning to work after fusion. The strongest predictor of RTW status was a history of psychiatric disease indicating the potential impact of better screening and treatment for psychiatric disorders before lumbar fusion. The low return to work rates and other generally poor outcomes reported in this study may suggest a more limited role for spinal fusion in patients with degenerative disk disease and diskogenic low back pain who are receiving workers’ compensation. The authors hope that the results presented herein can help to identify which patients receiving workers’ compensation may present a greater clinical challenge after diskogenic fusion. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
additional surgery. Psychiatric comorbidity increased after fusion but was much higher in those who did not return to work. CONCLUSIONS: Among 686 subjects who had workers’ compensation claims in Ohio and underwent lumbar fusion for spondylolisthesis from 1993 to 2013, the authors identified a number of preoperative prognostic factors for postoperative return to work. The strongest negative predictors were depression, prolonged time out of work, and long-term opioid analgesia. Given the poor return to work outcomes linked to depression and the apparent increase in psychiatric comorbidity after fusion, this finding may highlight a potential effect of better screening and treatment of psychiatric disorders before lumbar fusion is performed in patients with workers’ compensation claims. Future studies are needed to identify how to better facilitate return to work among similar patients with workers’ compensation claims. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
http://dx.doi.org/10.1016/j.spinee.2016.07.494
http://dx.doi.org/10.1016/j.spinee.2016.07.495
P169. Prognostic Factors for Return to Work Status following Lumbar Fusion among Workers’ Compensation Subjects with Spondylolisthesis Joshua T. Anderson1, Jay M. Levin, BA2, Arnold Haas, BS3, Nicholas U. Ahn, MD4; 1Cleveland Heights, OH, USA; 2University Hospital Case Medical Center, Department of Orthopaedic Surgery, Cleveland, OH, USA; 3Ohio Bureau of Worker’s Compensation, Columbus, OH, USA; 4University Hospital of Cleveland, Department of Orthopedic Surgery, Cleveland, OH, USA
P170. Multilevel Lumbar Fusion is Associated with Lower Return to Work Rates among Workers’ Compensation Subjects with Degenerative Disc Disease Joshua T. Anderson1, Jeffrey A. O’Donnell, BS2, Arnold Haas, BS3, Nicholas U. Ahn, MD4; 1Cleveland Heights, OH, USA; 2University Hospitals Case Medical Center, Department of Orthopaedic Surgery, Cleveland, OH, USA; 3Ohio Bureau of Worker’s Compensation, Columbus, OH, USA; 4University Hospital of Cleveland, Department of Orthopedic Surgery, Cleveland, OH, USA
BACKGROUND CONTEXT: Lumbar fusion for spondylolisthesis is associated with consistent outcomes in the general population. However, workers’ compensation is a risk factor for worse outcomes. Few studies have evaluated prognostic factors within this clinically distinct population. PURPOSE: The goal of this study was to identify prognostic factors for return to work among patients with workers’ compensation claims after fusion for spondylolisthesis. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Six hundred eighty-six subjects from the Ohio Bureau of Workers’ Compensation who underwent fusion for spondylolisthesis from 1993 to 2013. OUTCOME MEASURES: Primary outcome was whether the subjects met the return to work criteria. Positive return to work status was recorded in patients who returned to work within 2 years of fusion and remained working for longer than 6 months. Secondary outcomes measured within 3 years after index fusion included: days out of work, medical costs paid by the Ohio Bureau of Workers’ Compensation, use of opioid analgesics, development of new psychiatric comorbidity, use of psychotherapy, and rates of failed back syndrome, permanent disability benefits, all-cause mortality, postoperative infection, Pseudoarthrosis and additional lumbar surgery. METHODS: The authors used International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes to identify subjects from the Ohio Bureau of Workers’ Compensation who underwent fusion for spondylolisthesis from 1993 to 2013. Positive return to work status was recorded in patients who returned to work within 2 years of fusion and remained working for longer than 6 months. The authors used a multivariate logistic regression analysis to identify prognostic factors for return to work. RESULTS: Of the 686 subjects identified, criteria for return to work were met by 29.9% (n=205) of subjects. Negative preoperative prognostic factors for postoperative return to work included: out of work for longer than 1 year before fusion (p<.001; odds ratio [OR], 0.16); depression (p=.007; OR<0.01); long-term opioid analgesic use (p=.006; OR, 0.41); lumbar stenosis (p=.043; OR, 0.55); and legal representation (p=.042; OR, 0.63). Return to work rates associated with these factors were 9.7%, 0.0%, 10.0%, 29.2%, and 25.0%, respectively. If these subjects were excluded, the return to work rate increased to 60.4%. The 70.1% (n=481) of subjects who did not return to work had markedly worse outcomes, shown by higher medical costs, chronic opioid dependence, and higher rates of failed back syndrome, total disability, and
BACKGROUND CONTEXT: Lumbar fusion for degenerative disc disease (DDD) is associated with variable clinical outcomes, especially if multiple levels are fused. Reports exist of greater risk for reoperation, adjacent segment disease and nonunion with multi-level fusion (MLF). Few studies evaluate fusion outcomes within the clinically-distinct WC population, who are consistently reported to have worse surgical outcomes compared to the general population. PURPOSE: Determine the impact that levels fused has on postoperative return to work (RTW) status in a WC setting. STUDY DESIGN/SETTING: Retrospective Cohort Study. PATIENT SAMPLE: The study included 937 subjects from the Ohio Bureau of Workers’ Compensation (BWC) that underwent lumbar fusion for DDD between 1993 and 2013. OUTCOME MEASURES: The ability to RTW within 2 years of fusion and sustain this for greater than 6 months of the following year. Secondary outcomes: opioid analgesic utilization, rates of postoperative failed back syndrome, psychiatric disorder diagnosis, additional lumbar surgery, and permanent disability. METHODS: A retrospective cohort study of 937 subjects from the Ohio Bureau of Workers’ Compensation (BWC) who underwent single or multilevel discogenic fusion between the years of 1993 and 2013 was performed. ICD-9 and CPT codes were utilized to identify all subjects. Subjects with fewer than 3 years postoperative follow-up, a history of prior lumbar surgery, smoking, failed back syndrome, or psychiatric disorders were excluded from this study. A multivariate logistic regression analysis was used. RESULTS: Three hundred eighty-two subjects (40.8%) received MLF and 555 (59.2%) received single level fusion. Subjects were out of work for 903 days on average after fusion. Only 21.7% of the MLF group met our RTW criteria compared to 28.1% of the SLF group (p<.028). Multi-level fusion was a negative predictor of RTW status (p<.041; OR 0.71). Additional preoperative negative predictors included: prolonged time out of work (p<.001; OR 0.28), male gender (p<.018; OR 0.67), chronic opioid analgesia (p<.003; 0.49), and legal representation (p<.003; OR 0.56). Among all subjects after fusion, 11.3% developed failed back syndrome, 37.9% began permanent disability benefits, 21.5% were diagnosed with new psychiatric disorders, and 20.7% underwent additional lumbar surgery. Subjects utilized opioid analgesics for 657 on average. CONCLUSIONS: We identified multilevel discogenic fusion as a negative predictor of postoperative RTW status when compared to single level
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S251–S337
RESULTS: Two hundred fifty-eight patients were included (NR=208, RI=38, RC=12). Mean time to re-operation (n=50) was 496 days. Rod fractures (15) and PJK (9) were the most common indications for revisions. For RC patients, hardware failure (3) and sagittal imbalance (4) were the most prevalent re-operation drivers. All patients improved in all HRQL at 2-years compared to baseline (p<.05) except for MCS in the RI group, and MCS, SRS Ac and SRS Ment for RC patients (p>.05). Scores between NR and RI groups were different at each time in ODI, MCS, PCS, SRS Ac, SRS Pa and SRS Tot (p<.05); RC group had worse ODI, SRS Ac, SRS Pa and SRS Tot compared to NR at all times (p<.05); RC-S1 and RC-R1 displayed similar raw HRQL scores at all follow-up and overall. Normalized IHS HRQL for RI were worse for PCS, SRS Ac and SRS App compared to NR (p<.05), indicating less improvement during 2-year recovery period. RC-R1 IHS were significantly worse than RI in MCS, SRS Ment, SRS Satis and SRS Tot (p<.05). CONCLUSIONS: ASD patients indicated for revisions for radiographic and implant-related complications differ significantly in their overall 2-year recovery process compared to primary patients, using a normalized IHS method for determining HRQL changes. Traditional methods analyzing revision patients’ recovery kinetics may overestimate their improvements. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.492
P167. The Influence of Sub-Diagnosis on Radiographic and Clinical Outcomes after Lumbar Fusion for Degenerative Disc Disorders: a 15-Year Meta-Analysis Amandeep Bhalla, MD1, Andrew J. Schoenfeld, MD2, Jaiben George, MD3, Christopher M. Bono, MD2; 1Long Beach, CA, USA; 2 Brigham and Women’s Hospital, Boston, MA, USA; 3Cleveland Clinic, Cleveland, OH, USA BACKGROUND CONTEXT: There is a large body of literature describing lumbar fusion surgery and associated clinical and radiographic outcomes for degenerative disc diseases, considered together as a broad category. However, there is scant discussion in the literature of how outcomes for lumbar fusion are influenced by preoperative diagnosis. PURPOSE: By performing a 15-year meta-analysis, the authors sought to better understand the relationship between preoperative diagnosis and outcomes for lumbar fusion surgery. STUDY DESIGN/SETTING: Meta-analysis. PATIENT SAMPLE: Adult patients undergoing spinal fusion surgery for degenerative disc disorders of the lumbar spine. OUTCOME MEASURES: VAS scores, complication rates, & fusion rates were measured and stratified by preoperative diagnosis. METHODS: With adherence to the PRISMA guidelines for meta-analysis, electronic searches were performed through PubMed, Scopus, and Web of Science to gather all studies involving lumbar fusion for degenerative disc disorders from January 2000 to August 2014. A detailed analysis of papers yielded by the query was performed. Disorders occurring at various points along the degenerative cascade were included, namely, degenerative spondylolisthesis (DDDsp), adult degenerative scoliosis (DDDsc), painful, dynamically unstable, degenerative disc disease (DDDu) (excluding spondylolisthesis), and degenerative disc disease not specified as stable or unstable (DDDn). Exclusion criteria included revision surgeries and the diagnosis of isthmic spondylolisthesis or spinal stenosis alone. Abstracted information included diagnosis, fusion technique, study design, number of levels fused, length of follow up, complication rate, and validated outcome measures. RESULTS: One hundred articles met inclusion criteria and yielded data for 8,706 patients. There was 91.7% agreement between reviewers on inclusion of abstracts for the study. This results in a Cohen’s kappa=0.49. The most common diagnosis was DDDn (44%), followed by DDDsp (43%), DDDsc (11%), and DDDu (2%). The mean clinical improvement in VAS scores was significantly different among the diagnoses (p<.001) with DDDsp demonstrating the highest improvement (60%) and DDDns having the lowest
(45%). Complication rates also differed significantly based on the diagnosis (p<.001), with highest rate seen in the DDDsc group (18%), followed by DDDsp (14%), DDDn (12%), and DDDu (7%). There was not a significant difference in the fusion rates by preoperative diagnosis. CONCLUSIONS: The preoperative diagnosis of degenerative spondylolisthesis showed a statistically significant clinical benefit from lumbar fusion compared to other diagnoses. The senior author (CB) performed a similar analysis of the literature over a 20-year period (1979–2000), and published findings indicative of a relationship between preoperative diagnosis and outcomes (Bono & Lee, 2005). The prior study, as well as this one, shows DDDsc to have the highest complication rate. Over the past 15 years, when compared to the prior 20 years, there is greater success in achieving bony fusion, regardless of preoperative diagnosis. This information may be helpful in discussing anticipated outcomes of lumbar fusion surgery for patients with lumbar degenerative disc disorders. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.493
P168. Predictors of Return to Work after Lumbar Fusion for Degenerative Disc Disease in Workers’ Compensation Subjects Joshua T. Anderson1, Erik Tye, BA2, Arnold Haas, BS3, Nicholas U. Ahn, MD4; 1Cleveland Heights, OH, USA; 2Case Western Reserve University School of Medicine, Cleveland, OH, USA; 3Ohio Bureau of Worker’s Compensation, Columbus, OH, USA; 4University Hospital of Cleveland, Department of Orthopedic Surgery, Cleveland, OH, USA BACKGROUND CONTEXT: Lumbar fusion for the indication of degenerative disk disease (DDD) and diskogenic low back pain is associated with variable clinical outcomes. In addition, US patients with workers’ compensation (WC) claims often have worse fusion outcomes than the general population. Few studies have evaluated the risk factors for poor outcomes within this clinically distinct population. PURPOSE: The purpose of the study was to identify preoperative factors that predicted return to work (RTW) status after diskogenic lumbar fusion in patients with workers’ compensation claims. STUDY DESIGN/SETTING: Retrospective cohort study of a workers’ compensation population. PATIENT SAMPLE: Two hundred forty-one subjects met our RTW criteria. The remaining 796 formed the out of work (OOW) group. OUTCOME MEASURES: The primary outcome measure of this study was whether subjects met the authors’ criteria for return to work. Secondary outcomes within 3 years after index fusion included: days out of work, medical costs paid by the Ohio Bureau of WC, opioid analgesic use, use of physical therapy and chiropractic care, rates of new psychiatric comorbidity, development of failed back syndrome, pseudoarthrosis, newly awarded permanent disability benefits, all-cause mortality and revision surgery. METHODS: The authors used International Classification of Diseases, Ninth Revision (ICD-9), diagnosis and Current Procedural Terminology (CPT) procedural codes to identify 1,037 subjects from the Ohio Bureau of WC database who underwent fusion for DDD between 1993 and 2013 with at least 3 years of follow-up. To identify preoperative predictors of postoperative return to work status, the authors used multivariate logistic regression analysis, adjusting for many important covariates. RESULTS: Significant negative preoperative predictors of RTW status included: being out of work for greater than 1 year (p<.001; odds ratio [OR], 0.24), psychiatric history (p<.001; OR 0.14), male sex (p=.014; OR 0.65), prolonged use of opioid analgesics greater than 1 year (p<.001; OR 0.46), and legal representation (p=.042; OR 0.67). The return to work rates associated with these risk factors were 10.4%, 2.0%, 21.1%, 11.9%, and 20.7% respectively. Of the study subjects, 76.8% (n=796) did not return to work and had considerably worse postoperative outcomes, highlighted by chronic opioid dependence, high rates of failed back syndrome, additional surgery, and new psychiatric comorbidity.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S251–S337
S325
CONCLUSIONS: This study identified a number of significant predictors for worse return to work outcomes within a large population of subjects with workers’ compensation claims. Psychiatric disorders, legal representation, extensive work loss, and prolonged opioid use before fusion negatively affected the likelihood of returning to work after fusion. The strongest predictor of RTW status was a history of psychiatric disease indicating the potential impact of better screening and treatment for psychiatric disorders before lumbar fusion. The low return to work rates and other generally poor outcomes reported in this study may suggest a more limited role for spinal fusion in patients with degenerative disk disease and diskogenic low back pain who are receiving workers’ compensation. The authors hope that the results presented herein can help to identify which patients receiving workers’ compensation may present a greater clinical challenge after diskogenic fusion. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
additional surgery. Psychiatric comorbidity increased after fusion but was much higher in those who did not return to work. CONCLUSIONS: Among 686 subjects who had workers’ compensation claims in Ohio and underwent lumbar fusion for spondylolisthesis from 1993 to 2013, the authors identified a number of preoperative prognostic factors for postoperative return to work. The strongest negative predictors were depression, prolonged time out of work, and long-term opioid analgesia. Given the poor return to work outcomes linked to depression and the apparent increase in psychiatric comorbidity after fusion, this finding may highlight a potential effect of better screening and treatment of psychiatric disorders before lumbar fusion is performed in patients with workers’ compensation claims. Future studies are needed to identify how to better facilitate return to work among similar patients with workers’ compensation claims. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
http://dx.doi.org/10.1016/j.spinee.2016.07.494
http://dx.doi.org/10.1016/j.spinee.2016.07.495
P169. Prognostic Factors for Return to Work Status following Lumbar Fusion among Workers’ Compensation Subjects with Spondylolisthesis Joshua T. Anderson1, Jay M. Levin, BA2, Arnold Haas, BS3, Nicholas U. Ahn, MD4; 1Cleveland Heights, OH, USA; 2University Hospital Case Medical Center, Department of Orthopaedic Surgery, Cleveland, OH, USA; 3Ohio Bureau of Worker’s Compensation, Columbus, OH, USA; 4University Hospital of Cleveland, Department of Orthopedic Surgery, Cleveland, OH, USA
P170. Multilevel Lumbar Fusion is Associated with Lower Return to Work Rates among Workers’ Compensation Subjects with Degenerative Disc Disease Joshua T. Anderson1, Jeffrey A. O’Donnell, BS2, Arnold Haas, BS3, Nicholas U. Ahn, MD4; 1Cleveland Heights, OH, USA; 2University Hospitals Case Medical Center, Department of Orthopaedic Surgery, Cleveland, OH, USA; 3Ohio Bureau of Worker’s Compensation, Columbus, OH, USA; 4University Hospital of Cleveland, Department of Orthopedic Surgery, Cleveland, OH, USA
BACKGROUND CONTEXT: Lumbar fusion for spondylolisthesis is associated with consistent outcomes in the general population. However, workers’ compensation is a risk factor for worse outcomes. Few studies have evaluated prognostic factors within this clinically distinct population. PURPOSE: The goal of this study was to identify prognostic factors for return to work among patients with workers’ compensation claims after fusion for spondylolisthesis. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Six hundred eighty-six subjects from the Ohio Bureau of Workers’ Compensation who underwent fusion for spondylolisthesis from 1993 to 2013. OUTCOME MEASURES: Primary outcome was whether the subjects met the return to work criteria. Positive return to work status was recorded in patients who returned to work within 2 years of fusion and remained working for longer than 6 months. Secondary outcomes measured within 3 years after index fusion included: days out of work, medical costs paid by the Ohio Bureau of Workers’ Compensation, use of opioid analgesics, development of new psychiatric comorbidity, use of psychotherapy, and rates of failed back syndrome, permanent disability benefits, all-cause mortality, postoperative infection, Pseudoarthrosis and additional lumbar surgery. METHODS: The authors used International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes to identify subjects from the Ohio Bureau of Workers’ Compensation who underwent fusion for spondylolisthesis from 1993 to 2013. Positive return to work status was recorded in patients who returned to work within 2 years of fusion and remained working for longer than 6 months. The authors used a multivariate logistic regression analysis to identify prognostic factors for return to work. RESULTS: Of the 686 subjects identified, criteria for return to work were met by 29.9% (n=205) of subjects. Negative preoperative prognostic factors for postoperative return to work included: out of work for longer than 1 year before fusion (p<.001; odds ratio [OR], 0.16); depression (p=.007; OR<0.01); long-term opioid analgesic use (p=.006; OR, 0.41); lumbar stenosis (p=.043; OR, 0.55); and legal representation (p=.042; OR, 0.63). Return to work rates associated with these factors were 9.7%, 0.0%, 10.0%, 29.2%, and 25.0%, respectively. If these subjects were excluded, the return to work rate increased to 60.4%. The 70.1% (n=481) of subjects who did not return to work had markedly worse outcomes, shown by higher medical costs, chronic opioid dependence, and higher rates of failed back syndrome, total disability, and
BACKGROUND CONTEXT: Lumbar fusion for degenerative disc disease (DDD) is associated with variable clinical outcomes, especially if multiple levels are fused. Reports exist of greater risk for reoperation, adjacent segment disease and nonunion with multi-level fusion (MLF). Few studies evaluate fusion outcomes within the clinically-distinct WC population, who are consistently reported to have worse surgical outcomes compared to the general population. PURPOSE: Determine the impact that levels fused has on postoperative return to work (RTW) status in a WC setting. STUDY DESIGN/SETTING: Retrospective Cohort Study. PATIENT SAMPLE: The study included 937 subjects from the Ohio Bureau of Workers’ Compensation (BWC) that underwent lumbar fusion for DDD between 1993 and 2013. OUTCOME MEASURES: The ability to RTW within 2 years of fusion and sustain this for greater than 6 months of the following year. Secondary outcomes: opioid analgesic utilization, rates of postoperative failed back syndrome, psychiatric disorder diagnosis, additional lumbar surgery, and permanent disability. METHODS: A retrospective cohort study of 937 subjects from the Ohio Bureau of Workers’ Compensation (BWC) who underwent single or multilevel discogenic fusion between the years of 1993 and 2013 was performed. ICD-9 and CPT codes were utilized to identify all subjects. Subjects with fewer than 3 years postoperative follow-up, a history of prior lumbar surgery, smoking, failed back syndrome, or psychiatric disorders were excluded from this study. A multivariate logistic regression analysis was used. RESULTS: Three hundred eighty-two subjects (40.8%) received MLF and 555 (59.2%) received single level fusion. Subjects were out of work for 903 days on average after fusion. Only 21.7% of the MLF group met our RTW criteria compared to 28.1% of the SLF group (p<.028). Multi-level fusion was a negative predictor of RTW status (p<.041; OR 0.71). Additional preoperative negative predictors included: prolonged time out of work (p<.001; OR 0.28), male gender (p<.018; OR 0.67), chronic opioid analgesia (p<.003; 0.49), and legal representation (p<.003; OR 0.56). Among all subjects after fusion, 11.3% developed failed back syndrome, 37.9% began permanent disability benefits, 21.5% were diagnosed with new psychiatric disorders, and 20.7% underwent additional lumbar surgery. Subjects utilized opioid analgesics for 657 on average. CONCLUSIONS: We identified multilevel discogenic fusion as a negative predictor of postoperative RTW status when compared to single level
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.