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Factors Associated with Return-to-Work following Cervical Spine Surgery in Non-Worker's Compensation Setting.

Spine 2019 January 8
STUDY DESIGN: This study retrospectively analyzes prospectively collected data.

OBJECTIVE: Here in this study we aim to determine the factors which impact a patient's ability to RTW in the setting of cervical spine surgery in patients without worker's compensation status.

SUMMARY OF BACKGROUND DATA: Surgical management of degenerative cervical disease has proven cost-effectiveness and shown significant improvement in quality of life. However, the ability to return to work (RTW) is an important clinical outcome for preoperatively employed patients.

METHODS: All adult patients undergoing elective surgery for cervical degenerative disease at our institution are enrolled in a prospective, web-based registry. A multivariable Cox proportional hazards regression model was built for time to RTW. The variables included in the model were age, gender, smoking status, occupation type, number of levels operated on, ASA grade, BMI, history of diabetes, history of CAD, history of COPD, anxiety, depression, myelopathy at presentation, duration of symptoms > 12 months, diagnosis, type of surgery performed, and preoperative NDI, EQ-5D, NRS-NP, and NRS-AP scores.

RESULTS: Of the total 324 patients with complete three-month follow-up data 83% (n = 269) returned to work following surgery. The median time to RTW was 35 days (range: 2-90 days). Patients with a labor-intensive occupation, higher ASA grade, history of CAD, and history of COPD were less likely to RTW. The likelihood of RTW was lower in patients with a diagnosis of disc herniation compared to cervical stenosis, patients undergoing cervical corpectomy compared laminectomy and fusion and patient with longer operative time.

CONCLUSION: Our study identifies the various factors associated with a lower likelihood of RTW at three months after cervical spine surgery in the non-worker's compensation setting. This information provides expectations for the patient and employer when undergoing cervical spine surgery.

LEVEL OF EVIDENCE: 3.

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