Impact of occupational characteristics on return to work for employed patients after elective cervical spine surgery

Hani Chanbour Departments of Neurological Surgery,

Search for other papers by Hani Chanbour in
jns
Google Scholar
PubMed
Close
 MD
,
Jacquelyn S. Pennings Orthopaedic Surgery, and
Center for Musculoskeletal Research, Vanderbilt University Medical Center;
Biostatistics, Vanderbilt University Medical Center;

Search for other papers by Jacquelyn S. Pennings in
jns
Google Scholar
PubMed
Close
 PhD
,
Claudia Davidson Orthopaedic Surgery, and

Search for other papers by Claudia Davidson in
jns
Google Scholar
PubMed
Close
 MS
,
Andrew J. Croft Orthopaedic Surgery, and

Search for other papers by Andrew J. Croft in
jns
Google Scholar
PubMed
Close
 MD
,
Jeffrey W. Chen Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas;

Search for other papers by Jeffrey W. Chen in
jns
Google Scholar
PubMed
Close
 BA
,
Wilson E. Vaughan Tulane University, School of Medicine, New Orleans, Louisiana; and

Search for other papers by Wilson E. Vaughan in
jns
Google Scholar
PubMed
Close
 MS
,
Inamullah Khan Department of Neurological Surgery, University of Missouri Health Care, Columbia, Missouri

Search for other papers by Inamullah Khan in
jns
Google Scholar
PubMed
Close
 MD
,
Kristin R. Archer Orthopaedic Surgery, and
Center for Musculoskeletal Research, Vanderbilt University Medical Center;
Department of Physical Medicine & Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee;

Search for other papers by Kristin R. Archer in
jns
Google Scholar
PubMed
Close
 PhD, DPT
,
Raymond J. Gardocki Orthopaedic Surgery, and

Search for other papers by Raymond J. Gardocki in
jns
Google Scholar
PubMed
Close
 MD
,
Amir M. Abtahi Departments of Neurological Surgery,
Orthopaedic Surgery, and

Search for other papers by Amir M. Abtahi in
jns
Google Scholar
PubMed
Close
 MD
,
Byron F. Stephens Departments of Neurological Surgery,
Orthopaedic Surgery, and

Search for other papers by Byron F. Stephens in
jns
Google Scholar
PubMed
Close
 MD, MSCI
, and
Scott L. Zuckerman Departments of Neurological Surgery,
Orthopaedic Surgery, and

Search for other papers by Scott L. Zuckerman in
jns
Google Scholar
PubMed
Close
 MD, MPH
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $392.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $636.00
USD  $45.00
USD  $392.00
USD  $636.00
Print or Print + Online Sign in

OBJECTIVE

In a cohort of employed patients undergoing elective cervical spine surgery with an uncomplicated postoperative course, the authors sought to determine the demographic, functional, and occupational characteristics associated with return to work (RTW) following surgery.

METHODS

A retrospective cohort study of prospectively collected data was undertaken of patients undergoing elective cervical spine surgery for degenerative disease in the Quality Outcomes Database. Study inclusion criteria were: 1) employed prior to surgery and planned to RTW, 2) no unplanned readmissions, 3) achieved 30% improvement on the Neck Disability Index (NDI), and 4) were satisfied with the surgical outcome at 3 or 12 months postoperatively. A multivariable Cox regression model was built using demographic, functional, operative, and occupational characteristic to predict time to RTW.

RESULTS

Of 5110 included patients, 4788 (93.7%) returned to work within 12 months, with a median time of 35 (IQR 19–60) days. Patients who did RTW were significantly younger (51.3 ± 9.4 vs 55.8 ± 9.6 years, p < 0.001), more often underwent an anterior approach (85.8% vs 80.7%, p = 0.009), were significantly more privately insured (82.1% vs 64.0%, p < 0.001), and were less likely to have workers’ disability insurance (6.7% vs 14.6%, p < 0.001) compared with patients who did not RTW. On multivariable Cox regression, demographic factors associated with a longer RTW were older age (hazard ratio [HR] 0.99, 95% CI 0.99–1.00, p < 0.001) and Black race (HR 0.71, 95% CI 0.62–0.81, p < 0.001). Male sex was associated with a shorter RTW time (HR 1.19, 95% CI 1.11–1.26, p < 0.001). Regarding baseline functional status, worse preoperative NDI (HR 0.99, 95% CI 0.99–0.99, p < 0.001) was associated with a longer RTW, whereas the absence of myelopathy was associated with a shorter RTW (HR 1.17, 95% CI 1.09–1.25, p < 0.001). Having a sedentary (HR 1.81, 95% CI 1.65–1.99, p < 0.001), light-intensity (HR 1.60, 95% CI 1.45–1.76, p < 0.001), and medium-intensity (HR 1.11, 95% CI 1.01–1.22, p = 0.037) occupation was associated with a shorter RTW time compared with a heavy-intensity occupation at any time point. Heavy-intensity occupations were independently the strongest predictor of longer RTW. Similar predictors of shorter RTW were found in a subanalysis of occupation intensity and among operative approaches used.

CONCLUSIONS

Among patients undergoing elective degenerative cervical spine surgery who had favorable surgical outcomes and planned to RTW before surgery, 94% had a successful RTW. Age was the strongest predictor of lower odds of RTW. Regarding time to RTW, having a sedentary, light-intensity, or medium-intensity occupation was associated with a shorter RTW time compared with a heavy-intensity occupation. These findings highlight the importance of considering the demographic and occupational characteristics when predicting postoperative RTW in patients with satisfactory surgical outcomes.

ABBREVIATIONS

HR = hazard ratio; NDI = Neck Disability Index; NRS = numeric rating scale; QOD = Quality Outcomes Database; RTW = return to work; Wald-df = Wald chi-square − degrees of freedom.
  • Collapse
  • Expand
  • 1

    Marquez-Lara A, Nandyala SV, Fineberg SJ, Singh K. Current trends in demographics, practice, and in-hospital outcomes in cervical spine surgery: a national database analysis between 2002 and 2011. Spine (Phila Pa 1976). 2014;39(6):476481.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Oglesby M, Fineberg SJ, Patel AA, Pelton MA, Singh K. Epidemiological trends in cervical spine surgery for degenerative diseases between 2002 and 2009. Spine (Phila Pa 1976). 2013;38(14):12261232.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Lubelski D, Alentado V, Nowacki AS, et al. Preoperative nomograms predict patient-specific cervical spine surgery clinical and quality of life outcomes. Neurosurgery. 2018;83(1):104113.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Graver V, Ljunggren AE, Loeb M, Haaland AK, Lie H, Magnaes B. Background variables (medical history, anthropometric and biological factors) in relation to the outcome of lumbar disc surgery. Scand J Rehabil Med. 1998;30(4):221225.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Moreland DB, Asch HL, Clabeaux DE, et al. Anterior cervical discectomy and fusion with implantable titanium cage: initial impressions, patient outcomes and comparison to fusion with allograft. Spine J. 2004;4(2):184191.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Wong JJ, Côté P, Quesnele JJ, Stern PJ, Mior SA. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. Spine J. 2014;14(8):17811789.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Devin CJ, Bydon M, Alvi MA, et al. A predictive model and nomogram for predicting return to work at 3 months after cervical spine surgery: an analysis from the Quality Outcomes Database. Neurosurg Focus. 2018;45(5):E9.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Faour M, Anderson JT, Haas AR, et al. Return to work rates after single-level cervical fusion for degenerative disc disease compared with fusion for radiculopathy in a workers’ compensation setting. Spine (Phila Pa 1976). 2016;41(14):11601166.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Kim EJ, Chotai S, Wick JB, et al. Factors associated with return-to-work following cervical spine surgery in non-worker’s compensation setting. Spine (Phila Pa 1976). 2019;44(13):903907.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    McGirt MJ, Speroff T, Dittus RS, Harrell FE Jr, Asher AL. The National Neurosurgery Quality and Outcomes Database (N2QOD): general overview and pilot-year project description. Neurosurg Focus. 2013;34(1):E6.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Khan I, Bydon M, Archer KR, et al. Impact of occupational characteristics on return to work for employed patients after elective lumbar spine surgery. Spine J. 2019;19(12):19691976.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Ray TK, Pana-Cryan R. Work flexibility and work-related well-being. Int J Environ Res Public Health. 2021;18(6):3254.

  • 13

    Khan IS, Huang E, Maeder-York W, et al. Racial disparities in outcomes after spine surgery: a systematic review and meta-analysis. World Neurosurg. 2022;157:e232e244.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Reyes SG, Bajaj PM, Alvandi BA, Kurapaty SS, Patel AA, Divi SN. Impact of social determinants of health in spine surgery. Curr Rev Musculoskelet Med. 2023;16(1):2432.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Wang KY, Puvanesarajah V, Xu A, et al. Growing racial disparities in the utilization of adult spinal deformity surgery: an analysis of trends from 2004 to 2014. Spine (Phila Pa 1976). 2022;47(7):E283E289.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Martin JR, Wang TY, Loriaux D, et al. Race as a predictor of postoperative hospital readmission after spine surgery. J Clin Neurosci. 2017;46:2125.

  • 17

    Ghogawala Z, Terrin N, Dunbar MR, et al. Effect of ventral vs dorsal spinal surgery on patient-reported physical functioning in patients with cervical spondylotic myelopathy: a randomized clinical trial. JAMA. 2021;325(10):942951.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Peolsson A, Peolsson M. Predictive factors for long-term outcome of anterior cervical decompression and fusion: a multivariate data analysis. Eur Spine J. 2008;17(3):406414.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Asher AL, Devin CJ, Archer KR, et al. An analysis from the Quality Outcomes Database, part 2. Predictive model for return to work after elective surgery for lumbar degenerative disease. J Neurosurg Spine. 2017;27(4):370381.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Katz AS, Pronk NP, McLellan D, Dennerlein J, Katz JN. Perceived workplace health and safety climates: associations with worker outcomes and productivity. Am J Prev Med. 2019;57(4):487494.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Zigler JE, Rogers RW, Ohnmeiss DD. Comparison of 1-level versus 2-level anterior cervical discectomy and fusion: clinical and radiographic follow-up at 60 months. Spine (Phila Pa 1976). 2016;41(6):463469.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Capozzi LC, Dolgoy ND, McNeely ML. Physical rehabilitation and occupational therapy. Oral Maxillofac Surg Clin North Am. 2018;30(4):471486.

Metrics

All Time Past Year Past 30 Days
Abstract Views 1743 1743 1743
Full Text Views 23 23 23
PDF Downloads 31 31 31
EPUB Downloads 0 0 0