Effect of Worker’s Compensation Status on Pain, Disability, Quality of Life, and Return to Work After Lumbar Spine Surgery: A One-year Propensity-matched Analysis

Introduction: Compensation and litigation have been shown to adversely impact prognoses in a vast range of health conditions. The most frequent reason for workers' compensation (WC) claims is low back pain. Herein, we conducted the largest, and first propensity-matched comparison of outcomes between WC and non-WC patients who underwent lumbar laminectomy or lumbar fusion.

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

Results: 29,652 patients were included: Laminectomy (16,939 non-WC, 615 WC); Fusion (11,767 non-WC, 331 WC). WC patients were more frequently male or non-Caucasians, younger, less educated, and active smokers (p < 0.001). They had a healthier ASA grade and a lower co-morbidity burden, with greater baseline Oswestry Disability Index (ODI) and pain on the Visual Analogue Scale (VAS) (p < 0.001). One-year postoperative improvements in VAS, ODI, QALY, 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 greater 3- and 12-month VAS and ODI, reduced 12-month QALY-gain, and delayed return-to-work after both procedure types.

Conclusion : WC status was associated with significantly greater residual disability and pain post-operatively, lower quality of life, and delayed return to work. Utilizing resources to identify the negative influences on outcomes for WC patients may be of value in preoperative and perioperative optimization, and subsequently, better outcomes in these patients.