Tye Erik Y, Anderson Joshua T, Haas Arnold R, Percy Rick, Woods Stephen T, Ahn Uri M, Ahn Nicholas U
Case Western Reserve University School of Medicine.
Department of Orthopaedics, University Hospitals Case Medical Center, Cleveland, OH.
Clin Spine Surg. 2017 Dec;30(10):E1444-E1449. doi: 10.1097/BSD.0000000000000573.
Retrospective Cohort Study.
The objective of this study is to determine how time to surgery affects outcomes for degenerative lumbar stenosis (DLS) in a workers' compensation (WC) setting.
WC subjects are known to be a clinically distinct population with variable outcomes following lumbar surgery. No study has examined the effect of time to surgery in this clinically distinct population.
A total of 227 Ohio WC subjects were identified who underwent primary decompression for DLS between 1993 and 2013. We allocated patients into 2 groups: those that received operative decompression before and after 1 year of symptom onset. Our primary outcome was, if patients were able to make a stable return to work (RTW). The authors classified subjects as RTW if they returned within 2 years after surgery and remained working for >6 months.
The early cohort had a significantly higher RTW rate [50% (25/50) vs. 30% (53/117); P=0.01]. A logistic regression was performed to identify independent variables that predicted RTW status. Our regression model showed that time to surgery remained a significant negative predictor of RTW status (P=0.04; odds ratio, 0.48; 95% confidence interval, 0.23-0.91). Patients within the early surgery cohort cost on average, $37,332 less in total medical costs than those who opted for surgery after 1 year (P=0.01). Furthermore, total medical costs accrued over 3 years after index surgery was on average, $13,299 less when patients received their operation within 1 year after symptom onset (P=0.01).
Overall, time to surgery had a significant impact on clinical outcomes in WC subjects receiving lumbar decompression for DLS. Patients who received their operation within 1 year had a higher RTW rate, lower medical costs, and lower costs accrued over 3 years after index surgery. The results presented can perhaps be used to guide surgical decision-making and provide predictive value for the WC population.
回顾性队列研究。
本研究的目的是确定在工伤赔偿（WC）环境下，手术时间如何影响退行性腰椎管狭窄症（DLS）的治疗结果。
已知WC受试者是临床上独特的人群，腰椎手术后的结果各不相同。尚无研究探讨手术时间对这一临床独特人群的影响。
共确定了227名俄亥俄州WC受试者，他们在1993年至2013年间因DLS接受了初次减压手术。我们将患者分为两组：症状出现1年之前和之后接受手术减压的患者。我们的主要结局是患者是否能够稳定地重返工作岗位（RTW）。如果受试者在手术后2年内返回并持续工作超过6个月，作者将其归类为RTW。
早期队列的RTW率显著更高[50%（25/50）对30%（53/117）；P=0.01]。进行了逻辑回归分析，以确定预测RTW状态的独立变量。我们的回归模型显示，手术时间仍然是RTW状态的显著负预测因子（P=0.04；优势比，0.48；95%置信区间，0.23 - 0.91）。早期手术队列中的患者总医疗费用平均比那些在症状出现1年后选择手术的患者少37,332美元（P=0.01）。此外，当患者在症状出现后1年内接受手术时，初次手术后3年内产生的总医疗费用平均少13,299美元（P=0.01）。
总体而言，手术时间对接受DLS腰椎减压的WC受试者的临床结局有显著影响。在1年内接受手术的患者有更高的RTW率、更低的医疗费用以及初次手术后3年内产生的更低费用。所呈现的结果或许可用于指导手术决策，并为WC人群提供预测价值。
