Department of Orthopaedics, Geisel School of Medicine at Dartmouth College, Lebanon, NH 03756, USA.
Spine (Phila Pa 1976). 2013 May 15;38(11):953-64. doi: 10.1097/BRS.0b013e3182814ed5.
Prospective population-based cohort study.
To identify early predictors of lumbar spine surgery within 3 years after occupational back injury.
Back injuries are the most prevalent occupational injury in the United States. Few prospective studies have examined early predictors of spine surgery after work-related back injury.
Using Disability Risk Identification Study Cohort (D-RISC) data, we examined the early predictors of lumbar spine surgery within 3 years among Washington State workers, with new workers compensation temporary total disability claims for back injuries. Baseline measures included worker-reported measures obtained approximately 3 weeks after claim submission. We used medical bill data to determine whether participants underwent surgery, covered by the claim, within 3 years. Baseline predictors (P < 0.10) of surgery in bivariate analyses were included in a multivariate logistic regression model predicting lumbar spine surgery. The area under the receiver operating characteristic curve of the model was used to determine the model's ability to identify correctly workers who underwent surgery.
In the D-RISC sample of 1885 workers, 174 (9.2%) had a lumbar spine surgery within 3 years. Baseline variables associated with surgery (P < 0.05) in the multivariate model included higher Roland-Morris Disability Questionnaire scores, greater injury severity, and surgeon as first provider seen for the injury. Reduced odds of surgery were observed for those younger than 35 years, females, Hispanics, and those whose first provider was a chiropractor. Approximately 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor. The area under the receiver operating characteristic curve of the multivariate model was 0.93 (95% confidence interval, 0.92-0.95), indicating excellent ability to discriminate between workers who would versus would not have surgery.
Baseline variables in multiple domains predicted lumbar spine surgery. There was a very strong association between surgery and first provider seen for the injury even after adjustment for other important variables.
前瞻性基于人群的队列研究。
确定职业性腰背损伤后 3 年内腰椎手术的早期预测因素。
腰背损伤是美国最常见的职业性损伤。少数前瞻性研究探讨了与工作相关的腰背损伤后脊柱手术的早期预测因素。
利用残疾风险识别研究队列（D-RISC）的数据，我们检查了华盛顿州工人腰背损伤新工人赔偿临时完全残疾索赔后 3 年内腰椎手术的早期预测因素。基线测量包括索赔提交后大约 3 周工人报告的测量结果。我们使用医疗账单数据确定参与者是否在 3 年内接受了索赔涵盖的手术。在二元分析中，手术的基线预测因素（P<0.10）被纳入多变量逻辑回归模型，以预测腰椎手术。该模型的接收者操作特征曲线下面积用于确定该模型正确识别接受手术的工人的能力。
在 D-RISC 队列的 1885 名工人中，174 人（9.2%）在 3 年内接受了腰椎手术。在多变量模型中与手术相关的基线变量（P<0.05）包括更高的 Roland-Morris 残疾问卷评分、更严重的损伤程度以及受伤时首先就诊的外科医生。在年龄小于 35 岁、女性、西班牙裔和首先就诊的医生是脊椎按摩师的工人中，手术的可能性降低。与仅 1.5%首先就诊脊椎按摩师的工人相比，首先就诊外科医生的工人中有 42.7%接受了手术。多变量模型的接收者操作特征曲线下面积为 0.93（95%置信区间，0.92-0.95），表明该模型能够很好地区分进行手术和不进行手术的工人。
多个领域的基线变量预测了腰椎手术。即使在调整了其他重要变量后，手术与受伤时首先就诊的医生之间仍然存在很强的关联。
