Effect of Worker’s Compensation Status on Pain, Disability, Quality of Life, and Return to Work After Anterior Cervical Discectomy and Fusion: A One-year Propensity-matched Analysis

Introduction: Patients with Worker's Compensation (WC) claims are reported to demonstrate poor surgical outcomes after lumbar spine surgery. However, the effect of WC status on outcome after ACDF is poorly understood. Herein, we conducted the largest and first propensity-matched comparison of outcomes between WC and non-WC patients who underwent anterior cervical discectomy and fusion (ACDF).

Methods: Patients who underwent 1-4 level ACDF were retrospectively reviewed from the prospectively maintained National Quality Outcomes Database (QOD), which represents one-year patient-reported outcomes (PROs) from over 200 hospital systems from 2012-2021. After propensity matching, complications, utilization, patient satisfaction, physical disability(NDI), pain (VAS), health-state utility (QLY), and return-to-work were compared between WC and non-WC cohorts.

Results: 9,957 patients were included (9,610 non-WC, 347 WC). Patients in the WC cohort were significantly younger (50 ±9.1 vs. 56 ±11.4 years; p< 0.001), less educated, demonstrated a reduced osteoporotic burden (p < 0.001), and were more frequently male, non-Caucasians, and active smokers (29.1% vs. 18.1%; p< 0.001), with greater baseline VAS and NDI, and poorer quality of life (p < 0.001). One-year postoperative improvements in VAS, NDI, QLY, return to work rates, and satisfaction were all significantly worse for WC vs non-WC patients for both procedures. After adjusting for baseline differences via propensity matching, WC vs non-WC patients continued to demonstrate worse 3- and 12-month neck pain and NDI (p < 0.010), satisfaction (2=4.03 p=.045), and delayed return-to-work (9.3 weeks vs. 5.7 weeks for non-WC patients; p< 0.001). However, similar QLY and VAS for arm pain was observed between cohorts at 1 year.

Conclusion : WC status was associated with greater one-year residual disability and axial pain along with a delayed return to work, without any difference in the quality of life. Further studies are needed to determine the societal impact that WC claims have on healthcare delivery in the setting of ACDF.