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

Ummey Hani Department of Neurosurgery, Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;
SpineFirst, Charlotte, North Carolina; and

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Steve H. Monk Department of Neurosurgery, Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;
SpineFirst, Charlotte, North Carolina; and

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Deborah Pfortmiller Department of Neurosurgery, Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;
SpineFirst, Charlotte, North Carolina; and

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Gerry Stanley Harvard MedTech, Las Vegas, Nevada

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Paul K. Kim Department of Neurosurgery, Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;
SpineFirst, Charlotte, North Carolina; and

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Michael A. Bohl Department of Neurosurgery, Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;
SpineFirst, Charlotte, North Carolina; and

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Christopher M. Holland Department of Neurosurgery, Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;
SpineFirst, Charlotte, North Carolina; and

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Matthew J. McGirt Department of Neurosurgery, Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;
SpineFirst, Charlotte, North Carolina; and

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OBJECTIVE

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

ABBREVIATIONS

ACDF = anterior cervical discectomy and fusion; ASA = American Society of Anesthesiologists; MCID = minimal clinically important difference; NDI = Neck Disability Index; PRO = patient-reported outcome; PROM = PRO measure; QOD = Quality Outcomes Database; QOL = quality of life; VAS = visual analog scale; WC = workers’ compensation.
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Figure from Protopsaltis et al. (pp 757–764).
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