Return to Work After Diskogenic Fusion in Workers' Compensation Subjects

Lumbar fusion for degenerative disk disease (DDD) is associated with variable clinical outcomes. Patients with workers' compensation claims often have worse fusion outcomes than the general population. Few studies have evaluated the risk factors for poor outcomes within this clinically distinct population. The goal of this study was to identify preoperative predictors of return to work status after fusion for DDD in a workers' compensation setting. The authors used International Classification of Diseases, Ninth Revision (ICD-9), diagnosis and Current Procedural Terminology (CPT) procedural codes to identify 1037 subjects from the Ohio Bureau of Workers' Compensation database who underwent fusion for DDD between 1993 and 2013. Of these subjects, 23.2% (n=241) made a sustained return to work within 2 years after fusion. To identify preoperative predictors of postoperative return to work status, the authors used multivariate logistic regression analysis, adjusting for many important covariates. These included prolonged time out of work (P<.001; odds ratio [OR], 0.24), psychiatric history (P<.001; OR, 0.14), prolonged use of opioid analgesics (P<.001; OR, 0.46), male sex (P=.014; OR, 0.65), and legal representation (P=.042; OR, 0.67). The return to work rates associated with these risk factors were 10.4%, 2.0%, 11.9%, 21.1%, and 20.7%, respectively. Of the study subjects, 76.8% (n=796) did not return to work and had considerably worse postoperative outcomes, highlighted by chronic opioid dependence and high rates of failed back syndrome, additional surgery, and new psychiatric comorbidity. The low return to work rates and other generally poor outcomes reported in this study may indicate a more limited role for lumbar fusion among patients with DDD who have workers' compensation claims. More studies are needed to determine whether fusion for DDD can improve function and quality of life in these patients.