Predictor of Return to Work after Lumbar Discectomy

Little is known about factors that predict whether or when patients can return to work following surgery. “As well understood by this audience, lumbar disc herniation and concordant radiculopathy is a very common condition affecting approximately 5% of the population at any given time. In this country alone, more than 300,000 lumbar discectomies are performed each year making it the most common procedure done by neurosurgeons and orthopedic spine surgeons,” Dr. Than stated. Despite the number of discectomies performed, little is known about factors that predict whether or when patients can return to work following surgery. Predicting return to work can be important in analyzing a surgical procedure’s cost effectiveness.

NeuroPoint-SD
NeuroPoint-SD refers to Neurosurgery Patient Outcomes in Treating Spinal Disorders. It is a prospective, observational cohort registry at 13 academic and community sites. The study involved patients with single-level disc herniation who underwent single-level discectomy. The study focused on whether patients were working three months after surgery.

Patient Variables Assessed

• Age
• Gender
• Body mass index (BMI)
• SF-36
• Oswestry Disability Index (ODI) score
• Diabetes
• Systemic illness
• Smoking status
• Workers’ compensation status
• Preoperative work status

Dr. Than et al utilized a stepwise logistic regression analysis to identify which of these variables were predictors of return to work.

Results
Of 148 lumbar discectomy patients in the registry, 127 were available for analysis at three months.

• Average work time lost: 67 days
• Two-thirds of the patients were working three months after surgery.

Patient findings at three months postop:

• Younger (44.5 years vs 50.5 years, P=0.0008)
• Males (55.3% vs 28.6%, P=0.05)
• Higher baseline SF-36 physical function (44.0 vs 30.3, P=0.02)
• Lower baseline ODI (43.8 vs 52.6, P=0.01)
• Non-smokers (83.5% vs 66.7%, P=0.03)
• Working prior to lumbar discectomy (105 patients)

Dr. Than stated, “Looking only at patients working before surgery, it seemed that younger patients were those more likely to return to work, and this held true after logistic regression.”