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Long-term Outcomes of Lumbar Fusion Among Workers’ Compensation Subjects: A Historical Cohort Study

Nguyen, Trang H. MD, PhD*; Randolph, David C. MD, MPH*; Talmage, James MD; Succop, Paul PhD*; Travis, Russell MD

doi: 10.1097/BRS.0b013e3181ccc220
Epidemiology

Study Design. Historical cohort study.

Objective. To determine objective outcomes of return to work (RTW), permanent disability, postsurgical compli­cations, opiate utilization, and reoperation status for chronic low back pain subjects with lumbar fusion. Sim­ilarly, RTW status, permanent disability, and opiate utili­zation were also measured for nonsurgical controls.

Summary of Background Data. A historical cohort study of workers’ compensation (WC) subjects with lum­bar arthrodesis and randomly selected controls to evalu­ate multiple objective outcomes has not been previously published.

Methods. A total of 725 lumbar fusion cases were compared to 725 controls who were randomly selected from a pool of WC subjects with chronic low back pain diagnoses with dates of injury between January 1, 1999 and December 31, 2001. The study ended on January 31, 2006. Main outcomes were reported as RTW status 2 years after the date of injury (for controls) or 2 years after date of surgery (for cases). Disability, reoperations, complications, opioid usage, and deaths were also deter­mined.

Results. Two years after fusion surgery, 26% (n = 188) of fusion cases had RTW, while 67% (n = 483) of nonsur­gical controls had RTW (P ≤ 0.001) within 2 years from the date of injury. The reoperation rate was 27% (n = 194) for surgical patients. Of the lumbar fusion subjects, 36% (n = 264) had complications. Permanent disability rates were 11% (n = 82) for cases and 2% (n = 11) for nonoperative controls (P ≤ 0.001). Seventeen surgical patients and 11 controls died by the end of the study (P = 0.26). For lumbar fusion subjects, daily opioid use increased 41% after surgery, with 76% (n = 550) of cases continuing opioid use after surgery. Total number of days off work was more prolonged for cases compared to controls, 1140 and 316 days, respectively (P < 0.001). Final multi­variate, logistic regression analysis indicated the number of days off before surgery odds ratio [OR], 0.94 (95% confidence interval [CI], 0.92–0.97); legal representation OR, 3.43 (95% CI, 1.58–7.41); daily morphine usage OR, 0.83 (95% CI, 0.71–0.98); reoperation OR, 0.42 (95% CI, 0.26–0.69); and complications OR, 0.25 (95% CI, 0.07–0.90), are significant predictors of RTW for lumbar fusion patients.

Conclusion. This Lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a WC setting is associated with significant increase in disabil­ity, opiate use, prolonged work loss, and poor RTW status.

Lumbar fusion outcomes for workers compensation subjects with chronic low back pain are reported based on objective outcomes of return to work status and morphine use. This historical cohort study showed prolonged opioids usage and poor return to work status for workers compensation patients with lumbar fusion.

From the *Division of Epidemiology and Biostatistics, Department of ­Environmental Health, University of Cincinnati College of Medicine, Milford, OH

Meharry Medical College, Nashville, TN

Department of Physical Medicine and Rehabilitation, University of Kentucky College of Medicine, Lexington, KY.

Address correspondence and reprint requests to Trang H. Nguyen, MD, Division of Epidemiology and Biostatistics, Department of Envi­ronmental Health, University of Cincinnati College of Medicine, 5724 Signal Hill Center, ­Milford, OH; E-mail: dococcmed@aol.com

Acknowledgment date: July 1, 2009. Revision date: October 25, 2009. ­Acceptance date: November 25, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

IRB Approval: This study proposal was approved by the Institutional Review Board at the University Of Cincinnati College Of Medicine prior to beginning the study.

© 2011 by Lippincott Williams & Wilkins