1Department of Neurosurgery, Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
2SpineFirst, Charlotte, North Carolina; and.
J Neurosurg Spine. 2023 Mar 24;39(1):47-57. doi: 10.3171/2023.2.SPINE221341. Print 2023 Jul 1.
Workers' compensation (WC) and litigation have been shown to adversely impact prognoses in a vast range of health conditions. Low-back pain is currently the most frequent reason for WC claims. The objective of this study was to conduct the largest propensity-matched comparison of outcomes between patients with WC and non-WC status who underwent lumbar spinal decompression with and without fusion.
Complete data sets for patients who underwent 1- to 4-level lumbar spinal fusion or decompression alone were retrospectively retrieved from the Quality Outcomes Database (QOD), which included 1-year patient-reported outcomes from more than 200 hospital systems collected from 2012 to 2021. Population demographics, perioperative safety, facility utilization, patient satisfaction, disability, pain, EQ-5D quality of life, and return to work (RTW) rates were compared between cohorts for both subgroups. Statistical significance was set at p < 0.05.
There were 29,652 patients included in the study. Laminectomy was performed in 16,939 with non-WC status and in 615 with WC, whereas fusion was performed in 11,767 with non-WC status and in 331 with WC. WC patients were more frequently male, a minority race, younger, less educated, more frequently a smoker, had a healthier American Society of Anesthesiologists grade, and with greater baseline visual analog scale (VAS) and Oswestry Disability Index (ODI) scores (p < 0.001). One-year postoperative improvements in VAS, ODI, quality-adjusted life years (QALYs), RTW rates, and satisfaction were all significantly worse for WC versus non-WC patients for both procedures. After adjusting for baseline differences via propensity matching, WC versus non-WC patients continued to demonstrate worse 3- and 12-month VAS and ODI scores, reduced 12-month QALY gain, and delayed RTW after both procedure types.
WC status was associated with significantly greater residual disability and pain postoperatively, a lower quality of life, and delayed RTW. Utilizing resources to identify the negative influences on outcomes for WC patients may be valuable in preoperative optimization and could yield better outcomes in these patients.
工人赔偿（WC）和诉讼已被证明会对广泛的健康状况产生不利影响。下背痛是目前 WC 索赔最常见的原因。本研究的目的是对接受腰椎减压术和融合术的 WC 患者和非 WC 患者进行最大的倾向性匹配比较，以比较他们的结果。
从质量结果数据库（QOD）中回顾性检索了接受 1-4 级腰椎融合术或单纯减压术患者的完整数据集，该数据库包括了 2012 年至 2021 年期间从 200 多个医院系统收集的 1 年患者报告结果。比较了两组患者的人口统计学、围手术期安全性、设施利用率、患者满意度、残疾、疼痛、EQ-5D 生活质量和重返工作岗位（RTW）率。统计显著性设为 p < 0.05。
本研究共纳入 29652 名患者。非 WC 组行椎板切除术 16939 例，WC 组行椎板切除术 615 例；非 WC 组行融合术 11767 例，WC 组行融合术 331 例。WC 患者中男性、少数族裔、年轻、受教育程度较低、吸烟较多、美国麻醉医师协会（ASA）分级较高、基线视觉模拟量表（VAS）和 Oswestry 残疾指数（ODI）评分较高的患者比例较高（p < 0.001）。与非 WC 患者相比，两种手术的 WC 患者术后 1 年 VAS、ODI、质量调整生命年（QALY）、RTW 率和满意度的改善均显著较差。通过倾向性匹配调整基线差异后，WC 患者与非 WC 患者在术后 3 个月和 12 个月时的 VAS 和 ODI 评分仍较差，12 个月时的 QALY 获益减少，且两种手术类型后 RTW 延迟。
WC 状态与术后显著的残余残疾和疼痛、较低的生活质量以及 RTW 延迟有关。利用资源确定 WC 患者对结果的负面影响可能有助于术前优化，并可能为这些患者带来更好的结果。
