McMillan Janine S, Jones Kyle, Forgan Leonard, Busija Ljoudmila, Carey Roy P L, de Silva Andrea M, Phillips Mark G
Institute for Safety, Compensation and Recovery Research (ISCRR), Monash University, Melbourne, Victoria, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
ANZ J Surg. 2022 Mar;92(3):481-486. doi: 10.1111/ans.17391. Epub 2021 Nov 25.
Lumbar spinal fusion (LSF) outcomes for workers' compensation patients are worse than for the general population. The objectives were to examine the long-term work capacity, opioid prescription and mental health outcomes of injured workers who have undergone LSF surgery in Victoria, Australia, and to identify demographic and pre- and post-operative characteristics associated with these outcomes.
Retrospective study of 874 injured workers receiving elective LSF from 2008 to 2016 in the Victorian workers' compensation system. WorkSafe Victoria's claims data were used to infer outcomes for recovery. Association of demographics, pre-surgery and surgery variables with outcomes were modelled using multivariate multinomial logistic regression analyses.
Twenty-four months after LSF surgery, 282 (32.3%) of the 874 injured workers had substantial work capacity, 388 (44.4%) were prescribed opioids, and 330 (37.8%) were receiving mental health treatment. Opioid prescription and limited work capacity before surgery were independent strong predictors of opioid prescription, reduced work capacity and mental health treatment 24 months after LSF. Pre-operative mental health treatment was associated with the use of mental health treatment at 24 months. Other predictors for poor outcomes included a greater than 12-month duration from injury to surgery, LSF re-operation and common law or impairment benefit lodgement before surgery.
An association between pre-operative factors and post-operative outcomes after LSF in a Victorian workers' compensation population was identified, suggesting that pre-operative status may influence outcomes and should be considered in LSF decisions. The high opioid use indicates that opioid management before and after surgery needs urgent review.
工伤赔偿患者的腰椎融合术（LSF）结果比普通人群更差。目的是研究在澳大利亚维多利亚州接受LSF手术的受伤工人的长期工作能力、阿片类药物处方和心理健康结果，并确定与这些结果相关的人口统计学以及术前和术后特征。
对2008年至2016年在维多利亚州工伤赔偿系统中接受择期LSF的874名受伤工人进行回顾性研究。利用维多利亚州职业健康与安全管理局的索赔数据推断恢复结果。使用多变量多项逻辑回归分析对人口统计学、术前和手术变量与结果之间的关联进行建模。
LSF手术后24个月，874名受伤工人中有282名（32.3%）具有较高的工作能力，388名（44.4%）被开具阿片类药物处方，330名（37.8%）正在接受心理健康治疗。术前阿片类药物处方和工作能力受限是LSF术后24个月阿片类药物处方、工作能力下降和心理健康治疗的独立强预测因素。术前心理健康治疗与24个月时使用心理健康治疗有关。其他不良结果的预测因素包括受伤至手术的时间超过12个月、LSF再次手术以及术前普通法或损伤福利申请。
在维多利亚州工伤赔偿人群中，确定了LSF术前因素与术后结果之间的关联，这表明术前状态可能影响结果，在LSF决策中应予以考虑。阿片类药物的高使用率表明，手术前后的阿片类药物管理需要紧急审查。
