DiGiorgio Anthony M, Mummaneni Praveen V, Park Paul, Chan Andrew K, Bisson Erica F, Bydon Mohamad, Foley Kevin T, Glassman Steven D, Shaffrey Christopher I, Potts Eric A, Shaffrey Mark E, Coric Domagoj, Knightly John J, Wang Michael Y, Fu Kai-Ming, Asher Anthony L, Virk Michael S, Kerezoudis Panagiotis, Alvi Mohammed Ali, Guan Jian, Haid Regis W, Slotkin Jonathan R
1Department of Neurological Surgery, University of California, San Francisco, California.
2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California.
Neurosurg Focus. 2020 May 1;48(5):E5. doi: 10.3171/2020.2.FOCUS191022.
Return to work (RTW) and satisfaction are important outcome measures after surgery for degenerative spine disease. The authors queried the prospective Quality Outcomes Database (QOD) to determine if RTW correlated with patient satisfaction.
The QOD was queried for patients undergoing surgery for degenerative lumbar spondylolisthesis. The primary outcome of interest was correlation between RTW and patient satisfaction, as measured by the North American Spine Society patient satisfaction index (NASS). Secondarily, data on satisfied patients were analyzed to see what patient factors correlated with RTW.
Of 608 total patients in the QOD spondylolisthesis data set, there were 292 patients for whom data were available on both satisfaction and RTW status. Of these, 249 (85.3%) were satisfied with surgery (NASS score 1-2), and 224 (76.7%) did RTW after surgery. Of the 68 patients who did not RTW after surgery, 49 (72.1%) were still satisfied with surgery. Of the 224 patients who did RTW, 24 (10.7%) were unsatisfied with surgery (NASS score 3-4). There were significantly more people who had an NASS score of 1 in the RTW group than in the non-RTW group (71.4% vs 42.6%, p < 0.05). Failure to RTW was associated with lower level of education, worse baseline back pain (measured with a numeric rating scale), and worse baseline disability (measured with the Oswestry Disability Index [ODI]).
There are a substantial number of patients who are satisfied with surgery even though they did not RTW. Patients who were satisfied with surgery and did not RTW typically had worse preoperative back pain and ODI and typically did not have a college education. While RTW remains an important measure after surgery, physicians should be mindful that patients who do not RTW may still be satisfied with their outcome.
重返工作岗位（RTW）和满意度是退行性脊柱疾病手术后重要的结局指标。作者查询了前瞻性质量结果数据库（QOD），以确定RTW与患者满意度之间是否存在关联。
在QOD中查询接受退行性腰椎滑脱手术的患者。主要关注的结局是RTW与患者满意度之间的关联，通过北美脊柱协会患者满意度指数（NASS）进行测量。其次，对满意患者的数据进行分析，以查看哪些患者因素与RTW相关。
在QOD腰椎滑脱数据集中的608例患者中，有292例患者同时有满意度和RTW状态的数据。其中，249例（85.3%）对手术满意（NASS评分1 - 2），224例（76.7%）术后重返工作岗位。在术后未重返工作岗位的68例患者中，49例（72.1%）仍对手术满意。在224例重返工作岗位的患者中，24例（10.7%）对手术不满意（NASS评分3 - 4）。重返工作岗位组中NASS评分为1的人数显著多于未重返工作岗位组（71.4%对42.6%，p < 0.05）。未重返工作岗位与较低的教育水平、更严重的基线背痛（用数字评分量表测量）以及更严重的基线残疾（用Oswestry残疾指数[ODI]测量）相关。
有相当数量的患者尽管未重返工作岗位，但对手术仍感到满意。对手术满意但未重返工作岗位的患者通常术前背痛和ODI更严重，且通常没有大学学历。虽然重返工作岗位仍然是手术后的一项重要指标，但医生应注意，未重返工作岗位的患者可能仍对其手术结果感到满意。
