Young J N, Shaffrey C I, Laws E R, Lovell L R
Department of Neurosurgery, Portsmouth Naval Medical Center, VA, USA.
Surg Neurol. 1997 Dec;48(6):552-8; discussion 558-9. doi: 10.1016/s0090-3019(97)00393-5.
Reported outcomes in patients undergoing surgical procedures for lumbar disc herniation are poorer in patients eligible for workers' compensation or with pending litigation. In the civilian community, the amount of compensation for one's disability is variable and thus its influence on surgical outcome is difficult to quantify. In the military, all members are covered by a standardized workers' compensation system, and have generally standardized work requirements, a standard pay scale, and third party evaluation of disability based on the Veterans Affairs rating system. This made the military a good system in which to study the effect of potential compensation on surgical outcome.
The study population consisted of active duty military members who underwent sequential lumbar microdiscectomies over a 31-month period. Omitted were lumbar fusions, decompressive laminectomies, and far lateral discectomies. Clinical and demographic variables, along with financial data for each patient were derived from these data. A good result was defined as return to active military duty.
Three hundred forty-nine lumbar discectomies were performed in 348 active duty military members. Overall, 75.3% (262) of the 348 patients were able to return to full military duty after surgery, and 24.7% (86) received disability compensation. Chi-square univariate analysis showed higher compensation incentive was a significant determinant of poor surgical outcome (p = 0.0021). The influence of compensation incentive was proportional to the amount of anticipated payout, and relative to a military service member's usual income. In mutivariate analysis, lower base pay (0.0005) and female gender (p = 0.038) were predictive of poor outcome.
Secondary gain in the form of disability pay has a proportionally adverse effect on outcome following lumbar disc surgery. Although studying this issue in the military system allowed standardization of secondary gain values, the influence of other factors could not be eliminated entirely. Potential disability pay is proportionally greater in lower ranked service members. Thus, other variables such as income level, education, and job satisfaction may contribute to the poorer results in this subgroup of military members.
据报道，符合工伤赔偿条件或有未决诉讼的腰椎间盘突出症手术患者的治疗结果较差。在平民群体中，个人残疾赔偿金额各不相同，因此其对手术结果的影响难以量化。在军队中，所有成员都纳入标准化的工伤赔偿体系，并且通常有标准化的工作要求、标准薪资等级，以及基于退伍军人事务评级系统的第三方残疾评估。这使得军队成为研究潜在赔偿对手术结果影响的理想体系。
研究对象为在31个月期间接受连续腰椎显微椎间盘切除术的现役军人。腰椎融合术、减压性椎板切除术和极外侧椎间盘切除术被排除在外。从这些数据中获取临床和人口统计学变量以及每位患者的财务数据。良好结果定义为重返现役。
348名现役军人接受了349例腰椎间盘切除术。总体而言，348例患者中有75.3%（262例）术后能够重返全职军事任务，24.7%（86例）获得了残疾赔偿。卡方单因素分析显示，更高的赔偿激励是手术结果不佳的一个重要决定因素（p = 0.0021）。赔偿激励的影响与预期赔付金额成正比，且相对于军人的正常收入而言。在多因素分析中，较低的基本工资（0.0005）和女性性别（p = 0.038）可预测结果不佳。
以残疾抚恤金形式出现的继发性获益对腰椎手术后的结果有相应的不利影响。尽管在军队系统中研究这个问题使得继发性获益值能够标准化，但其他因素的影响无法完全消除。低级别军人的潜在残疾抚恤金相对更高。因此，其他变量，如收入水平、教育程度和工作满意度，可能导致这一亚组军人的结果更差。
