Time to return to work after elective lumbar spine surgery

Supriya Singh MD, MSc, FRCSC1, Tamir Ailon MD, MPH, FRCSC1, Greg McIntosh MSc2, Nicolas Dea MD, MSc, FRCSC1, Jerome Paquet MD, FRCSC3, Edward Abraham MD, FRCSC4, Christopher S. Bailey MD, MSc, FRCSC5, Michael H. Weber MD, PhD, FRCSC6, Michael G. Johnson MD, FRCSC7, Andrew Nataraj MD, MSc, FRCSC8, R. Andrew Glennie MD, MSc, FRCSC9, Najmedden Attabib MD, MBBCH, FRCSC10, Adrienne Kelly MD, FRCSC11, Hamilton Hall MD, FRCSC12, Y. Raja Rampersaud MD, FRCSC13, Neil Manson MD, FRCSC4, Philippe Phan MD, PhD, FRCSC14, Kenneth Thomas MD, FRCSC15, Charles G. Fisher MD, MHSC, FRCSC1, and Raphaële Charest-Morin MD, FRCSC1
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  • 1 Combined Neurosurgical and Orthopedic Spine Service, Department of Orthopedic Surgery, University of British Columbia, Vancouver, British Columbia;
  • | 2 Canadian Spine Outcomes and Research Network, Markdale, Ontario;
  • | 3 Centre de Recherche CHU de Quebec, CHU de Québec-Université Laval, Quebec City, Quebec;
  • | 4 Canada East Spine Centre, Saint John Orthopedics, Dalhousie Medicine New Brunswick, Saint John Campus, Saint John, New Brunswick;
  • | 5 London Health Science Centre, Western University, London, Ontario;
  • | 6 McGill University Health Centre, Montreal, Quebec;
  • | 7 Department of Surgery, Section of Orthopedics and Neurosurgery, University of Manitoba, Winnipeg, Manitoba;
  • | 8 Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alberta;
  • | 9 Department of Surgery, Dalhousie University, Halifax, Nova Scotia;
  • | 10 Canada East Spine Centre, Division of Neurosurgery, Zone 2, Horizon Health Network, Saint John, New Brunswick;
  • | 11 Sault Area Hospital, Northern Ontario School of Medicine, Sault Ste. Marie, Ontario;
  • | 12 Department of Surgery, University of Toronto, Toronto, Ontario;
  • | 13 Divisions of Orthopaedic and Neurosurgery, University of Toronto, Toronto, Ontario;
  • | 14 The Ottawa Hospital, Ottawa, Ontario;
  • | 15 University of Calgary, Calgary, Alberta, Canada
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OBJECTIVE

Time to return to work (RTW) after elective lumbar spine surgery is variable and dependent on many factors including patient, work-related, and surgical factors. The primary objective of this study was to describe the time and rate of RTW after elective lumbar spine surgery. Secondary objectives were to determine predictors of early RTW (< 90 days) and no RTW in this population.

METHODS

A retrospective analysis of prospectively collected data from the multicenter Canadian Spine Outcomes and Research Network (CSORN) surgical registry was performed to identify patients who were employed and underwent elective 1- or 2-level discectomy, laminectomy, and/or fusion procedures between January 2015 and December 2019. The percentage of patients who returned to work and the time to RTW postoperatively were calculated. Predictors of early RTW and not returning to work were determined using a multivariable Cox regression model and a multivariable logistic regression model, respectively.

RESULTS

Of the 1805 employed patients included in this analysis, 71% returned to work at a median of 61 days. The median RTW after a discectomy, laminectomy, or fusion procedure was 51, 46, and 90 days, respectively. Predictors of early RTW included male gender, higher education level (high school or above), higher preoperative Physical Component Summary score, working preoperatively, a nonfusion procedure, and surgery in a western Canadian province (p < 0.05). Patients who were working preoperatively were twice as likely to RTW within 90 days (HR 1.984, 95% CI 1.680–2.344, p < 0.001) than those who were employed but not working. Predictors of not returning to work included symptoms lasting more than 2 years, an increased number of comorbidities, an education level below high school, and an active workers’ compensation claim (p < 0.05). There were fourfold odds of not returning to work for patients who had not been working preoperatively (OR 4.076, 95% CI 3.087–5.383, p < 0.001).

CONCLUSIONS

In the Canadian population, 71% of a preoperatively employed segment returned to work after 1- or 2-level lumbar spine surgery. Most patients who undergo a nonfusion procedure RTW after 6 to 8 weeks, whereas patients undergoing a fusion procedure RTW at 12 weeks. Working preoperatively significantly increased the likelihood of early RTW.

ABBREVIATIONS

ASA = American Society of Anesthesiologists; BMI = body mass index; CSORN = Canadian Spine Outcomes and Research Network; HRR = hazard rate ratio; MCS = Mental Component Summary; MIS = minimally invasive surgery; NRS = numeric rating scale; ODI = Oswestry Disability Index; PCS = Physical Component Summary; PHQ-9 = 9-item Patient Health Questionnaire; RTW = return to work.

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