Cook Chad E, Garcia Alessandra N, Shaffrey Christopher, Gottfried Oren
Duke University Division of Physical Therapy, Duke Department of Orthopaedic Surgery, Duke Clinical Research Institute, Durham, USA.
Physical Therapy Program, College of Pharmacy and Health Sciences, Campbell University, Lillington, USA.
Spine Surg Relat Res. 2020 Nov 20;5(3):182-188. doi: 10.22603/ssrr.2020-0156. eCollection 2021.
Employment status plays an essential role as a social determinant of health. Unemployed are more likely to have a longer length of hospital stay and a nearly twofold greater rate of 30 day readmission than those who were well employed at the time of back surgery. This study aimed to investigate whether employment status influenced post-surgery outcomes and if so, the differences were clinically meaningful among groups.
This retrospective observational study used data from the Quality Outcomes Database Lumbar Registry. Data refinement was used to isolate individuals 18 to 64 who received primary spine surgeries and had a designation of employed, unemployed, or disabled. Outcomes included 12 and 24 month back and leg pain, disability, patient satisfaction, and quality of life. Differences in descriptive variables, comorbidities, and outcomes measures (at 12 and 24 months) were analyzed using chi-square and linear mixed-effects modeling. When differences were present among groups, we evaluated whether they were clinically significant or not.
Differences (between employed, unemployed, and disabled) among baseline characteristics and comorbidities were present in nearly every category (p<0.01). In all cases, those who were disabled represented the least healthy, followed by unemployed, and then employed. Clinically meaningful differences for all outcomes were present at 12 and 24 months (p<0.01). In post hoc analyses, differences between each group at nearly all periods were found.
The findings support that the health-related characteristics are markedly different among employment status groups. Group designation strongly differentiated outcomes. These findings suggest that disability and unemployment should be considered when determining prognosis of the individual.
就业状况作为健康的社会决定因素起着至关重要的作用。与在接受背部手术时就业良好的人相比，失业者住院时间更长，30天再入院率几乎高出一倍。本研究旨在调查就业状况是否会影响术后结果，如果是，各群体之间的差异在临床上是否有意义。
这项回顾性观察研究使用了来自腰椎注册质量结果数据库的数据。数据细化用于分离18至64岁接受原发性脊柱手术且被指定为就业、失业或残疾的个体。结果包括12个月和24个月时的背部和腿部疼痛、残疾、患者满意度和生活质量。使用卡方检验和线性混合效应模型分析描述性变量、合并症和结果指标（12个月和24个月时）的差异。当组间存在差异时，我们评估它们是否具有临床意义。
几乎每个类别中（就业、失业和残疾之间）基线特征和合并症都存在差异（p<0.01）。在所有情况下，残疾者健康状况最差，其次是失业者，然后是就业者。所有结果在12个月和24个月时都存在具有临床意义的差异（p<0.01）。在事后分析中，几乎在所有时间段都发现了每组之间的差异。
研究结果支持就业状况组之间与健康相关的特征存在显著差异。分组显著区分了结果。这些发现表明，在确定个体预后时应考虑残疾和失业情况。
