Ren Bryan O, Rothfusz Christopher A, Faour Mhamad, Anderson Joshua T, O'Donnell Jeffrey A, Haas Arnold R, Percy Rick, Woods Stephen T, Ahn Uri M, Ahn Nicholas U
Orthopedics. 2020 May 1;43(3):154-160. doi: 10.3928/01477447-20200314-04. Epub 2020 Mar 20.
This study sought to determine the impact of time to surgery on clinical outcomes in patients with spondylolisthesis in the workers' compensation (WC) population. There is conflicting evidence regarding the effect of time to surgery on patients with spondylolisthesis. Patients receiving WC are known to have worse outcomes following spine surgery compared with the general population. A total of 791 patients from the Ohio Bureau of Workers' Compensation were identified who underwent lumbar fusion for spondylolisthesis between 1993 and 2013. The patients were divided into those who had surgery within 2 years of injury date and after 2 years. Confounding factors were corrected for in a multivariate logistic regression to determine predictors of return to work (RTW) status. Multivariate logistic regression determined that longer time to surgery (P=.003; odds ratio, 0.89 per year), age at index fusion (P=.003; odds ratio, 0.98 per year), and use of physical therapy before fusion (P=.008; odds ratio, 0.54) were negative predictors of RTW status. Patients who had surgery within 2 years were more likely to RTW and have fewer days absent from work, lower medical costs, and fewer sessions of psychotherapy, physical therapy, and chiropractor care. The authors demonstrated that for WC patients with spondylolisthesis, longer time to surgery was a negative predictor of RTW status. Patients who had surgery within 2 years of injury date were significantly more likely to RTW compared with after 2 years. [Orthopedics. 2020;43(3):154-160.].
本研究旨在确定手术时间对工人赔偿（WC）人群中腰椎滑脱患者临床结局的影响。关于手术时间对腰椎滑脱患者的影响，证据存在冲突。已知接受WC的患者与普通人群相比，脊柱手术后的结局更差。共确定了791例来自俄亥俄州工人赔偿局的患者，他们在1993年至2013年间因腰椎滑脱接受了腰椎融合手术。这些患者被分为在受伤日期后2年内接受手术的患者和2年后接受手术的患者。在多因素逻辑回归中对混杂因素进行校正，以确定重返工作岗位（RTW）状态的预测因素。多因素逻辑回归确定，手术时间延长（P = 0.003；比值比，每年0.89）、初次融合时的年龄（P = 0.003；比值比，每年0.98）以及融合前使用物理治疗（P = 0.008；比值比，0.54）是RTW状态的负性预测因素。在2年内接受手术的患者更有可能重返工作岗位，缺勤天数更少，医疗费用更低，心理治疗、物理治疗和脊椎按摩治疗的次数也更少。作者表明，对于WC腰椎滑脱患者，手术时间延长是RTW状态的负性预测因素。与受伤日期后2年接受手术的患者相比，在受伤日期后2年内接受手术的患者显著更有可能重返工作岗位。[《骨科》。2020年；43(3):154 - 160。]
