title: Predictors of vocational prognosis after herniated lumbar disc: a two-year follow-up study of 2039 patients diagnosed at hospital.
abstract: METHODS
  A register study with 2 years of follow up.
  
  
  OBJECTIVE
  To identify predictors of an unfavorable vocational prognosis after hospital contact for herniated lumbar disc (HLD).
  
  
  BACKGROUND
  There is sparse information about vocational prognosis among HLD patients diagnosed at hospital.
  
  
  METHODS
  We followed all in- and outpatients diagnosed with HLD at a Danish University Hospital 2001 to 2005 eligible for the labor market in the Danish National Register on Public Transfer Payments (n = 2039). Clinical data were obtained from the Danish National Patient Register. The outcome measure was unfavorable vocational prognosis defined as less than 40 weeks of employment within the second year after hospital contact. Cox proportional hazards models were used.
  
  
  RESULTS
  Altogether 41.8% had an unfavorable vocational prognosis. The outcome was associated with unskilled work Hazard Ratio (HR) 2.1 (95% confidence interval [CI] = 1.5-2.8), skilled work HR 1.9 (CI = 1.3-2.7), and semi academic work HR 1.5 (CI = 1.1-2.0) as compared with academic work and less than 40 weeks of employment within year two before hospital contact HR 2.1 (CI = 1.9-2.5). Further negative prognostic factors were lumbar fusion alone HR 1.4 (CI = 1.1-1.8) and in combination with discectomy HR 1.6 (CI = 1.2-2.2) as compared with nonsurgical treatment, ethnicity other than Danish HR 1.55 (CI = 1.2-1.8), and female gender HR 1.2 (CI = 1.1-1.4). Discectomy, age, and year of inclusion were not associated with the outcome.
  
  
  CONCLUSIONS
  The risk of an unfavorable vocational prognosis after hospital contact for HLD was substantial. Nonacademic work and less than 40 weeks of employment within year two before hospital contact were the strongest prognostic factors, but also lumbar fusion alone and in combination with discectomy, ethnicity, and gender had a negative influence. There seems to be a need for actions addressing these patient categories to avoid long-term sick leave and premature withdrawal from the labor market.
authors.affiliation: Department of Occupational Medicine, Danish Ramazzini Center, Aarhus University Hospital, Denmark. lonjesen@rm.dk
authors.forename: Lone Donbaek
authors.initials: LD
authors.lastname: Jensen
authors.forename: Poul
authors.initials: P
authors.lastname: Frost
authors.forename: Berit
authors.initials: B
authors.lastname: Schiøttz-Christensen
authors.forename: Thomas
authors.initials: T
authors.lastname: Maribo
authors.forename: Michael Victor
authors.initials: MV
authors.lastname: Christensen
authors.forename: Susanne Wulff
authors.initials: SW
authors.lastname: Svendsen
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004651:Employment / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D014938:Work Capacity Evaluation; D055815:Young Adult