Positive and negative work events attributed to the spine 2 years after lumbar surgery among patients working preoperatively

Abstract

OBJECTIVEReturn to work after lumbar surgery is not synonymous with effective job performance, and it is likely that patients who undergo spine surgery experience both positive and negative events attributable to their spine after returning to work. The authors’ objectives were to measure work events attributable to the spine during the 2 years after lumbar surgery and to assess associated demographic and clinical characteristics.METHODSEmployed patients scheduled for lumbar surgery were interviewed preoperatively and reported work characteristics, including amount of improvement in job performance that they expected from surgery. Clinical variables, such as comorbidities and surgical complexity, were collected using standard scales. Two years postoperatively patients completed the 22-item work domain of the Psychiatric Epidemiological Research Interview Life Events Scale (PERI) asking about major positive and negative events attributable to the spine that occurred since surgery. Event rates were assessed with logistic regression. Patients also reported the amount of improvement obtained in job performance, which was compared to the amount of improvement expected in bivariate analyses.RESULTSTwo hundred seven working patients (mean age 53 years, 62% men) were interviewed preoperatively. At 2 years after surgery, 86% were working and 12% reported negative events attributable to the spine (e.g., reduced workload, retirement). In multivariable analysis, high school education or less (OR 4.6, CI 1.7–12.3, p = 0.003), another spine surgery (OR 3.4, CI 1.2–10.1, p = 0.03), and new/worse comorbidity (OR 3.3, CI 1.2–8.8, p = 0.02) remained associated. Seven percent reported positive events attributable to the spine; not having postoperative complications was associated (OR 24, CI 4–156, p = 0.001). Of 162 patients queried preoperatively about expectations, 120 expected improvement in work; postoperatively, 82% reported some improvement (42% reported less improvement than expected and 40% as much as or more improvement than expected), 18% reported no improvement. No improvement was associated with less education (OR 1.5, CI 1.0–2.1, p = 0.04), older age (OR 1.1, CI 1.0–1.1, p = 0.005), more complex surgery (OR 1.1, CI 1.0–1.1, p = 0.07), and another spine surgery (OR 6.1, CI 1.9–19.8, p = 0.003). In descriptive analyses for another sample of preoperatively work-disabled patients, most had physically demanding jobs and only 33% returned to work postoperatively.CONCLUSIONSMost preoperatively working patients were working postoperatively, reported spine-related improvement in job performance, and reported the occurrence of both positive and negative work events attributable to the spine. This study proposes novel work outcomes (i.e., positive and negative work events) and potential methods to measure them.