Predicting Compensation and Medical Costs of Lumbar Fusion Patients Receiving Workersʼ Compensation in Utah Using Presurgical Biopsychosocial Variables

Wheeler, Anthony J.; Gundy, Jessica M.; DeBerard, M. Scott

doi:10.1097/brs.0b013e318226abf7

Cited by 9 publications

(5 citation statements)

References 15 publications

(16 reference statements)

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“…This may reflect the higher amounts paid for workers’ compensation claims, for which providers are reimbursed up to 150 % of the AMA listed fees, which are in turn higher than the government-subsidized fees listed in the Australian Medical Benefits Schedule. Lumbar fusion costs rose to AUD 81,297 at 24 months, which is lower than data from the US at USD 72,000 to 90,000 [ 11 , 22 ]. A cervical fusion cost AUD 37,291 in this study compared to USD 42,401 in the US, the latter of which included physiotherapy costs [ 23 ].…”

Section: Discussionmentioning

confidence: 84%

Rates, costs, return to work and reoperation following spinal surgery in a workers’ compensation cohort in New South Wales, 2010–2018: a cohort study using administrative data

Lewin

Fearnside

Kuru

et al. 2021

BMC Health Serv Res

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Background Internationally, elective spinal surgery rates in workers’ compensation populations are high, as are reoperation rates, while return-to-work rates following spinal surgery are low. Little information is available from Australia. The aim of this study was to describe the rates, costs, return to work and reoperation following elective spinal surgery in the workers’ compensation population in New South Wales (NSW), Australia. Methods This retrospective cohort study used administrative data from the State Insurance Regulatory Authority, the government organisation responsible for regulating and administering workers’ compensation insurance in NSW. These data cover all workers’ compensation-insured workers in New South Wales (over 3 million workers/year). We identified a cohort of insured workers who underwent elective spinal surgery (fusion or decompression) between January 1, 2010 and December 31, 2018. People who underwent surgery for spinal fracture or dislocation, or who had sustained a traumatic brain injury were excluded. The main outcome measures were annual spinal surgery rates, cost of the surgical episode, cumulative costs (surgical, hospital, medical and physical therapy) to 2 years post-surgery, and reoperation and return-to-work rates 2 years post-surgery. Results There were 9343 eligible claims (39.1 % fusion; 59.9 % decompression); claimants were predominantly male (75 %) with a mean age of 43 (range 18 to 75) years. Spinal surgery rates ranged from 15 to 29 surgeries per 100,000 workers per year, fell from 2011-12 to 2014-15 and rose thereafter. The average cost in Australian dollars for a surgical episode was $46,000 for a spinal fusion and $20,000 for a decompression. Two years post-fusion, only 19 % of people had returned to work at full capacity; 39 % after decompression. Nineteen percent of patients underwent additional spinal surgery within 2 years of the index surgery, to a maximum of 5 additional surgeries. Conclusion Rates of workers’ compensation-funded spinal surgery did not rise significantly during the study period, but reoperation rates are high and return-to-work rates are low in this population at 2 years post- surgery. In the context of the poor evidence base supporting lumbar fusion surgery, the high cost, increasing rates, and the increased likelihood of poor outcomes in the workers’ compensation population, we question the value of this procedure in this setting.

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Section: Discussionmentioning

confidence: 84%

Rates, costs, return to work and reoperation following spinal surgery in a workers’ compensation cohort in New South Wales, 2010–2018: a cohort study using administrative data

Lewin

Fearnside

Kuru

et al. 2021

BMC Health Serv Res

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“…6,8,[11][12][13][14][15][16][17] Relatively few studies have evaluated the risk factors for worse outcomes within this clinically distinct population. 6,9,12,13,20,21 Among the 1037 subjects identified in the Ohio Workers' Compensation database who underwent diskogenic fusion, the authors identified a number of preoperative factors that predicted postoperative return to work status. The strongest negative predictor of return to work status was a history of a psychiatric disorder before fusion, with an associated return to work rate of only 2.0%.…”

Section: Discussionmentioning

confidence: 99%

“…19 Even though workers' compensation is a welldescribed risk factor for worse outcomes, relatively few studies have evaluated this population for predictors of worse outcomes. 6,9,12,13,20,21 Among those receiving workers' compensation, the ability to return to work is of particular clinical importance, especially when considering that the estimated cost of treating chronic low back pain is greater than $100 billion per year in the United States, and two-thirds of this cost is believed to result from lost wages and reduced productivity. 22,23 Therefore, the authors wanted to identify preoperative factors that predicted return to work status after diskogenic lumbar fusion in patients with workers' compensation claims.…”

mentioning

confidence: 99%

Return to Work After Diskogenic Fusion in Workers' Compensation Subjects

Anderson

Haas²,

Percy³

et al. 2015

Orthopedics

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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.

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“…[6][7][8][9][10][11][12][13] Few studies have identified prognostic factors within this clinically distinct population. 6,12,14,18,19 The current study was the first to do so among patients with workers' compensation claims who underwent arthrodesis for spondylolisthesis. Among 686 subjects who had workers' compensation claims in Ohio and underwent lumbar fusion for spondylolisthesis from 1993 to 2013, the authors identified a number of preoperative prognostic factors for postoperative return to work.…”

Section: Discussionmentioning

confidence: 98%

“…However, relatively few studies have evaluated potential risk factors for poor outcomes after lumbar fusion among those receiving workers' compensation. 6,12,14,18,19 Therefore, the goal of this study was to identify prognostic factors for return to work status after lumbar fusion for spondylolisthesis within a workers' compensation setting. To the authors' knowledge, this is the first study to identify predictors of return to work specifically among patients with workers' compensation claims who underwent arthrodesis for spondylolisthesis.…”

mentioning

confidence: 99%

Workers' Compensation, Return to Work, and Lumbar Fusion for Spondylolisthesis

Haas¹,

Percy²,

Woods³

et al. 2016

Orthopedics

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Lumbar fusion for spondylolisthesis is associated with consistent outcomes in the general population. However, workers' compensation is a risk factor for worse outcomes. Few studies have evaluated prognostic factors within this clinically distinct population. The goal of this study was to identify prognostic factors for return to work among patients with workers' compensation claims after fusion for spondylolisthesis. The authors used International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes to identify 686 subjects from the Ohio Bureau of Workers' Compensation who underwent fusion for spondylolisthesis from 1993 to 2013. Positive return to work status was recorded in patients who returned to work within 2 years of fusion and remained working for longer than 6 months. The criteria for return to work were met by 29.9% (n=205) of subjects. The authors used multivariate logistic regression analysis to identify prognostic factors for return to work. Negative preoperative prognostic factors for postoperative return to work included: out of work for longer than 1 year before fusion (P<.001; odds ratio [OR], 0.16); depression (P=.007; OR<0.01); long-term opioid analgesic use (P=.006; OR, 0.41); lumbar stenosis (P=.043; OR, 0.55); and legal representation (P=.042; OR, 0.63). Return to work rates associated with these factors were 9.7%, 0.0%, 10.0%, 29.2%, and 25.0%, respectively. If these subjects were excluded, the return to work rate increased to 60.4%. The 70.1% (n=481) of subjects who did not return to work had markedly worse outcomes, shown by higher medical costs, chronic opioid dependence, and higher rates of failed back syndrome, total disability, and additional surgery. Psychiatric comorbidity increased after fusion but was much higher in those who did not return to work. Future studies are needed to identify how to better facilitate return to work among similar patients with workers' compensation claims.

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Predicting Compensation and Medical Costs of Lumbar Fusion Patients Receiving Workersʼ Compensation in Utah Using Presurgical Biopsychosocial Variables

Cited by 9 publications

References 15 publications

Rates, costs, return to work and reoperation following spinal surgery in a workers’ compensation cohort in New South Wales, 2010–2018: a cohort study using administrative data

Rates, costs, return to work and reoperation following spinal surgery in a workers’ compensation cohort in New South Wales, 2010–2018: a cohort study using administrative data

Return to Work After Diskogenic Fusion in Workers' Compensation Subjects

Workers' Compensation, Return to Work, and Lumbar Fusion for Spondylolisthesis

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