title: How to predict return to work after lumbar discectomy: answers from the NeuroPoint-SD registry.
abstract: OBJECTIVE To date, the factors that predict whether a patient returns to work after lumbar discectomy are poorly understood. Information on postoperative work status is important in analyzing the cost-effectiveness of the procedure. METHODS An observational prospective cohort study was completed at 13 academic and community sites (NeuroPoint-Spinal Disorders [NeuroPoint-SD] registry). Patients undergoing single-level lumbar discectomy were included. Variables assessed included age, sex, body mass index (BMI), SF-36 physical function score, Oswestry Disability Index (ODI) score, presence of diabetes, smoking status, systemic illness, workers' compensation status, and preoperative work status. The primary outcome was working status within 3 months after surgery. Stepwise logistic regression analysis was performed to determine which factors were predictive of return to work at 3 months following discectomy. RESULTS There were 127 patients (of 148 total) with data collected 3 months postoperatively. The patients' average age at the time of surgery was 46 ± 1 years, and 66.9% of patients were working 3 months postoperatively. Statistical analyses demonstrated that the patients more likely to return to work were those of younger age (44.5 years vs 50.5 years, p = 0.008), males (55.3% vs 28.6%, p = 0.005), those with higher preoperative SF-36 physical function scores (44.0 vs 30.3, p = 0.002), those with lower preoperative ODI scores (43.8 vs 52.6, p = 0.01), nonsmokers (83.5% vs 66.7%, p = 0.03), and those who were working preoperatively (91.8% vs 26.2%, p < 0.0001). When controlling for patients who were working preoperatively (105 patients), only age was a statistically significant predictor of postoperative return to work (44.1 years vs 51.1 years, p = 0.049). CONCLUSIONS In this cohort of lumbar discectomy patients, preoperative working status was the strongest predictor of postoperative working status 3 months after surgery. Younger age was also a predictor. Factors not influencing return to work in the logistic regression analysis included sex, BMI, SF-36 physical function score, ODI score, presence of diabetes, smoking status, and systemic illness. Clinical trial registration no.: 01220921 ( clinicaltrials.gov ).
authors.affiliation: Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon;
authors.forename: Khoi D
authors.initials: KD
authors.lastname: Than
authors.affiliation: Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts;
authors.forename: Jill N
authors.initials: JN
authors.lastname: Curran
authors.affiliation: Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Resnick
authors.affiliation: Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts;
authors.forename: Zoher
authors.initials: Z
authors.lastname: Ghogawala
authors.affiliation: Department of Neurosurgery, University of California, San Francisco, California.
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D062707:Return to Work; D013122:Spinal Diseases / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: BMI = body mass index; HIPAA = Health Insurance Portability and Accountability Act; IRB = institutional review board; NeuroPoint-SD = NeuroPoint–Spinal Disorders; ODI = Oswestry Disability Index; SPORT = Spine Patient Outcomes Research Trial; VAS = visual analog scale; lumbar discectomy; prospective registry; return to work