Adult Spinal Deformity Surgery Is Associated with Increased Productivity and Decreased Absenteeism From Work and School.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Feb 2022
15 Feb 2022
Historique:
pubmed:
6
11
2021
medline:
27
1
2022
entrez:
5
11
2021
Statut:
ppublish
Résumé
Retrospective cohort study. We hypothesized that adult spinal deformity (ASD) surgery would be associated with improved work- and school-related productivity, as well as decreased rates of absenteeism. ASD patients experience markedly decreased health-related quality of life along many dimensions. Only patients eligible for 2-year follow-up were included, and those with a history of previous spinal fusion were excluded. The primary outcome measures in this study were Scoliosis Research Society-22r score (SRS-22r) questions 9 and 17. A repeated measures mixed linear regression was used to analyze responses over time among patients managed operatively (OP) versus nonoperatively (NON-OP). In total, 1188 patients were analyzed. 66.6% were managed operatively. At baseline, the mean percentage of activity at work/school was 56.4% (standard deviation [SD] 35.4%), and the mean days off from work/school over the past 90 days was 1.6 (SD 1.8). Patients undergoing ASD surgery exhibited an 18.1% absolute increase in work/school productivity at 2-year follow-up versus baseline (P < 0.0001), while no significant change was observed for the nonoperative cohort (P > 0.5). Similarly, the OP cohort experienced 1.1 fewer absent days over the past 90 days at 2 years versus baseline (P < 0.0001), while the NON-OP cohort showed no such difference (P > 0.3). These differences were largely preserved after stratifying by baseline employment status, age group, sagittal vertical axis (SVA), pelvic incidence minus lumbar lordosis (PI-LL), and deformity curve type. ASD patients managed operatively exhibited an average increase in work/school productivity of 18.1% and decreased absenteeism of 1.1 per 90 days at 2-year follow-up, while patients managed nonoperatively did not exhibit change from baseline. Given the age distribution of patients in this study, these findings should be interpreted as pertaining primarily to obligations at work or within the home. Further study of the direct and indirect economic benefits of ASD surgery to patients is warranted.Level of Evidence: 3.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective cohort study.
OBJECTIVE
OBJECTIVE
We hypothesized that adult spinal deformity (ASD) surgery would be associated with improved work- and school-related productivity, as well as decreased rates of absenteeism.
SUMMARY OF BACKGROUND DATA
BACKGROUND
ASD patients experience markedly decreased health-related quality of life along many dimensions.
METHODS
METHODS
Only patients eligible for 2-year follow-up were included, and those with a history of previous spinal fusion were excluded. The primary outcome measures in this study were Scoliosis Research Society-22r score (SRS-22r) questions 9 and 17. A repeated measures mixed linear regression was used to analyze responses over time among patients managed operatively (OP) versus nonoperatively (NON-OP).
RESULTS
RESULTS
In total, 1188 patients were analyzed. 66.6% were managed operatively. At baseline, the mean percentage of activity at work/school was 56.4% (standard deviation [SD] 35.4%), and the mean days off from work/school over the past 90 days was 1.6 (SD 1.8). Patients undergoing ASD surgery exhibited an 18.1% absolute increase in work/school productivity at 2-year follow-up versus baseline (P < 0.0001), while no significant change was observed for the nonoperative cohort (P > 0.5). Similarly, the OP cohort experienced 1.1 fewer absent days over the past 90 days at 2 years versus baseline (P < 0.0001), while the NON-OP cohort showed no such difference (P > 0.3). These differences were largely preserved after stratifying by baseline employment status, age group, sagittal vertical axis (SVA), pelvic incidence minus lumbar lordosis (PI-LL), and deformity curve type.
CONCLUSION
CONCLUSIONS
ASD patients managed operatively exhibited an average increase in work/school productivity of 18.1% and decreased absenteeism of 1.1 per 90 days at 2-year follow-up, while patients managed nonoperatively did not exhibit change from baseline. Given the age distribution of patients in this study, these findings should be interpreted as pertaining primarily to obligations at work or within the home. Further study of the direct and indirect economic benefits of ASD surgery to patients is warranted.Level of Evidence: 3.
Identifiants
pubmed: 34738986
doi: 10.1097/BRS.0000000000004271
pii: 00007632-202202150-00001
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
287-294Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Références
Terran J, McHugh BJ, Fischer CR, et al. Surgical treatment for adult spinal deformity: projected cost effectiveness at 5-year follow-up. Ochsner J 2014; 14:14–22.
Bess S, Line B, Fu K-M, et al. The health impact of symptomatic adult spinal deformity: comparison of deformity types to United States population norms and chronic diseases. Spine (Phila Pa 1976) 2016; 41:224–233.
Fischer CR, Terran J, Lonner B, et al. Factors predicting cost-effectiveness of adult spinal deformity surgery at 2 years. Spine Deform 2014; 2:415–422.
International Spine Study G. Outcomes of operative and nonoperative treatment for adult spinal deformity: a prospective, multicenter, propensity-matched cohort assessment with minimum 2-year follow-up. Neurosurgery 2016; 78:851–861.
Hassanzadeh H, Jain A, El Dafrawy MH, et al. Clinical results and functional outcomes of primary and revision spinal deformity surgery in adults. J Bone Joint Surg Am 2013; 95:1413–1419.
Crawford CH III, Glassman SD, Bridwell KH, et al. The substantial clinical benefit threshold for SRS-22R domains after surgical treatment of adult spinal deformity. Spine Deform 2016; 4:373–377.
Fritz JM, Irrgang JJ. A comparison of a modified Oswestry low back pain disability questionnaire and the Quebec back pain disability scale. Phys Ther 2001; 81:776–788.
Fairbank J, Couper J, Davies J, et al. The Oswestry low back pain disability questionnaire. Physiotherapy 1980; 66:271–273.
Bridwell KH, Berven S, Glassman S, et al. Is the SRS-22 instrument responsive to change in adult scoliosis patients having primary spinal deformity surgery? Spine (Phila Pa 1976) 2007; 32:2220–2225.
Asher MA, Lai SM, Glattes RC, et al. Refinement of the SRS-22 health-related quality of life questionnaire function domain. Spine (Phila Pa 1976) 2006; 31:593–597.
Bae J, Theologis AA, Strom R, et al. Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance. J Neurosurg Spine 2018; 28:40–49.
Steenstra IA, Munhall C, Irvin E, et al. Systematic review of prognostic factors for return to work in workers with sub acute and chronic low back pain. J Occup Rehabil 2017; 27:369–381.
Neal CJ, Mandell K, Tasikas E, et al. Cost-effectiveness of adult spinal deformity surgery in a military healthcare system. Neurosurg Focus 2018; 45:E11.
Lavernia CJ, Alcerro JC. Quality of life and cost-effectiveness 1 year after total hip arthroplasty. J Arthroplasty 2011; 26:705–709.
Pellisé F, Vila-Casademunt A, Ferrer M, et al. Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J 2015; 24:3–11.
Fu K-MG, Bess RS, Schwab FJ, et al. Health impact comparison of different disease states and population norms to adult spinal deformity (ASD): a call for medical attention. Spine J 2012; 12:S2.
Liu S, Schwab F, Smith JS, et al. Likelihood of reaching minimal clinically important difference in adult spinal deformity: a comparison of operative and nonoperative treatment. Ochsner J 2014; 14:67–77.
Riley MS, Bridwell KH, Lenke LG, et al. Health-related quality of life outcomes in complex adult spinal deformity surgery. J Neurosurg Spine 2018; 28:194–200.
Acaroglu E, Yavuz AC, Guler UO, et al. A decision analysis to identify the ideal treatment for adult spinal deformity: is surgery better than non-surgical treatment in improving health-related quality of life and decreasing the disease burden? Eur Spine J 2016; 25:2390–2400.
Sciubba DM, Scheer JK, Yurter A, et al. Patients with spinal deformity over the age of 75: a retrospective analysis of operative versus non-operative management. Eur Spine J 2016; 25:2433–2441.
Reid DB, Daniels AH, Ailon T, et al. Frailty and health-related quality of life improvement following adult spinal deformity surgery. World Neurosurg 2018; 112:e548–e554.
Ames CP, Smith JS, Pellisé F, et al. Development of predictive models for all individual questions of SRS-22R after adult spinal deformity surgery: a step toward individualized medicine. Eur Spine J 2019; 28:1998–2011.