Retrospective Cohort Study.
The objective of this study is to determine how time to surgery affects outcomes for degenerative lumbar stenosis (DLS) in a workers’ compensation (WC) setting.
WC subjects are known to be a clinically distinct population with variable outcomes following lumbar surgery. No study has examined the effect of time to surgery in this clinically distinct population.
A total of 227 Ohio WC subjects were identified who underwent primary decompression for DLS between 1993 and 2013. We allocated patients into 2 groups: those that received operative decompression before and after 1 year of symptom onset. Our primary outcome was, if patients were able to make a stable return to work (RTW). The authors classified subjects as RTW if they returned within 2 years after surgery and remained working for >6 months.
The early cohort had a significantly higher RTW rate [50% (25/50) vs. 30% (53/117); P=0.01]. A logistic regression was performed to identify independent variables that predicted RTW status. Our regression model showed that time to surgery remained a significant negative predictor of RTW status (P=0.04; odds ratio, 0.48; 95% confidence interval, 0.23–0.91). Patients within the early surgery cohort cost on average, $37,332 less in total medical costs than those who opted for surgery after 1 year (P=0.01). Furthermore, total medical costs accrued over 3 years after index surgery was on average, $13,299 less when patients received their operation within 1 year after symptom onset (P=0.01).
Overall, time to surgery had a significant impact on clinical outcomes in WC subjects receiving lumbar decompression for DLS. Patients who received their operation within 1 year had a higher RTW rate, lower medical costs, and lower costs accrued over 3 years after index surgery. The results presented can perhaps be used to guide surgical decision-making and provide predictive value for the WC population.
*Case Western Reserve University School of Medicine
†Department of Orthopaedics, University Hospitals Case Medical Center, Cleveland, OH
‡Department of Orthopaedics, University of Utah, Salt Lake City, UT
§Ohio Bureau of Workers’ Compensation, Columbus, OH
∥New Hampshire NeuroSpine Institute, Bedford, NH
The authors declare no conflict of interest.
Reprints: Erik Y. Tye, BA, Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH 44106 (e-mail: firstname.lastname@example.org).
Received June 28, 2016
Accepted July 21, 2017