Returning to Work Within Two Years After First-Time, Single-Level, Simple Lumbar Discectomy: A Multifactorial,...

Area of Science:

• Orthopedics
• Occupational Health
• Health Services Research

Background:

• Inability to work post-lumbar discectomy has significant societal and individual impacts.
• Previous studies on return to work (RTW) after lumbar discectomy yielded conflicting results due to small sample sizes and reliance on patient-reported outcomes.
• Identifying factors for sustained RTW is crucial for patient recovery and economic participation.

Purpose of the Study:

• To describe the time to sustained return to work (RTW) within two years after lumbar discectomy using national database outcomes.
• To identify pre- and peri-operative factors associated with sustained RTW after lumbar discectomy.
• To develop and validate a predictive multivariable model for sustained RTW.

Main Methods:

• Utilized a national database for a cohort of 351 patients undergoing first-time, single-level lumbar discectomy who were on sick leave for over three weeks.
• Employed Kaplan-Meier plots to describe the time to sustained RTW.
• Applied a temporally validated Cox proportional hazards model to analyze associations between biopsychosocial factors and RTW.

Main Results:

• 62% of patients achieved sustained return to work (RTW) within two years, with a median time of 15 weeks.
• Factors positively associated with sustained RTW included higher education level, positive expectations for future employment, pre-operative stable labor market attachment, and better pre-operative physical quality of life and less disability.
• Disease-related clinical findings were generally not associated with sustained RTW.

Conclusions:

• A predictive model was developed and validated, identifying key patient-related factors influencing sustained return to work after lumbar discectomy.
• Patient characteristics such as education, expectations, pre-operative work status, and physical well-being are significant predictors of RTW.
• Clinical factors related to the lumbar discectomy itself appear less influential on sustained RTW compared to patient-specific psychosocial and economic factors.