Presurgical biopsychosocial variables predict medical, compensation, and aggregate costs of lumbar discectomy in Utah workers' compensation patients

The Impact of Workerʼs Compensation Claims on Outcomes and Costs Following an Anterior Cervical Discectomy and Fusion

“…However, a study of 266 WC patients from Utah demonstrated higher total accrued medical costs than those for non-WC patients after either open discectomy or microlumbar discectomy. 22 The authors concluded that biopsychosocial aspects (litigation, nurse case management, education, alcohol consumption) were signifi cant predictors of greater costs in WC patients. 22 Furthermore, multiple studies have attributed obesity, excessive imaging, and preoperative narcotic consumption for increased aggregate costs of WC patients after spine surgery.…”

“…22 The authors concluded that biopsychosocial aspects (litigation, nurse case management, education, alcohol consumption) were signifi cant predictors of greater costs in WC patients. 22 Furthermore, multiple studies have attributed obesity, excessive imaging, and preoperative narcotic consumption for increased aggregate costs of WC patients after spine surgery. [23][24][25] Despite the literature in support of increased aggregate medical costs in WC patients, our analysis of the acute hospitalization period after ACDF demonstrated similar costs between the cohorts.…”

Lumbar Surgery in Work-Related Chronic Low Back Pain: Can a Continuum of Care Enhance Outcomes?

“…6 Outcomes in the Utah WC jurisdiction were comparable. 10,11 In contrast, a previous prospective cohort study demonstrated high rates of work status improvement (>80%) and low rates of re-operation and recurrent injury claims for both fusion and discectomy patients in a chronic lumbar WC cohort. 12 This particular study utilized a "continuum of care approach," with administration of functional restoration after surgery for these patients.…”

“…Recent studies have documented the importance of psychosocial factors and their impact on outcomes following lumbar surgery, 11,[17][18][19][20] and the impact of psychosocial factors in the development and perpetuation of chronic pain and disability has been widely documented in the literature. 21,22 Because lumbar fusion surgery for nonspecific chronic low back pain (CLBP) is usually performed on patients already demonstrating extensive chronic pain/ disability behaviors in the WC setting, the need to pay heed to a biopsychosocial model when contemplating surgery, or managing them in post-operative rehabilitation, is becoming more apparent.…”

CORR Insights®: Which Variables Are Associated With Patient-reported Outcomes After Discectomy? Review of SPORT Disc Herniation Studies

“…All subgroups improved more with surgery than with nonoperative treatment with the exception of worker's compensation patients. Previous studies [1][2][3] have also found fewer self-reported beneficial effects of surgical procedures in workers compensation patients, but how this information is to be used remains unclear. Should surgeons withhold surgery to a patient with a workplace injury and an open claim who has clearly failed nonoperative intervention?…”