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Factors Associated With Return-to-Work Following Cervical Spine Surgery in Non-Worker's Compensation Setting

Kim, Elliott J. MD; Chotai, Silky MD∗,†; Wick, Joseph B. BA∗,†; Khan, Inamullah MD∗,†; Sivaganesan, Ahilan MD∗,†; Bydon, Mohamad MD§; Archer, Kristin R. PhD, DPT∗,†,‡; Devin, Clinton J. MD∗,†

doi: 10.1097/BRS.0000000000002978

Study Design. This study retrospectively analyzes prospectively collected data.

Objective. Here in this study we aim to determine the factors which impact a patient's ability to return to work (RTW) in the setting of cervical spine surgery in patients without worker's compensation status.

Summary of Background Data. Surgical management of degenerative cervical disease has proven cost-effectiveness and shown significant improvement in quality of life. However, the ability to RTW is an important clinical outcome for preoperatively employed patients.

Methods. All adult patients undergoing elective surgery for cervical degenerative disease at our institution are enrolled in a prospective, web-based registry. A multivariable Cox proportional hazards regression model was built for time to RTW. The variables included in the model were age, sex, smoking status, occupation type, number of levels operated on, ASA grade, body mass index, history of diabetes, history of coronary artery disease (CAD), history of chronic obstructive pulmonary disease (COPD), anxiety, depression, myelopathy at presentation, duration of symptoms more than 12 months, diagnosis, type of surgery performed, and preoperative Neck Disability Index, EuroQol Five Dimensions, and Numeric Rating Scale pain scores for neck pain and arm pain scores.

Results. Of the total 324 patients with complete 3-month follow-up data 83% (n = 269) returned to work following surgery. The median time to RTW was 35 days (range, 2–90 d). Patients with a labor-intensive occupation, higher ASA grade, history of CAD, and history of COPD were less likely to RTW. The likelihood of RTW was lower in patients with a diagnosis of disc herniation compared with cervical stenosis, patients undergoing cervical corpectomy compared laminectomy and fusion and patient with longer operative time.

Conclusion. Our study identifies the various factors associated with a lower likelihood of RTW at 3 months after cervical spine surgery in the non-worker's compensation setting. This information provides expectations for the patient and employer when undergoing cervical spine surgery.

Level of Evidence: 3

This study utilizes a multivariable Cox proportional hazards regression model to determine the factors affecting patients' ability to RTW in non-worker's compensation setting. Patients with a labor-intensive occupation, higher ASA grade, history of CAD, history of COPD, diagnosis of disc herniation and patient undergoing cervical corpectomy were less likely to RTW.

Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee

Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee

Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee

§Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota.

Address correspondence and reprint requests to Clinton J. Devin, MD, Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774; E-mail:

Received 18 June, 2018

Revised 15 October, 2018

Accepted 18 December, 2018

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

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants, expert testimony.

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