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Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State.

Authors
Keeney-BJ; Fulton-Kehoe-D; Turner-JA; Wickizer-TM; Chan-KC; Franklin-GM
Source
Spine 2013 May; 38(11):953-964
NIOSHTIC No.
20043539
Abstract
STUDY DESIGN: Prospective population-based cohort study. OBJECTIVE: To identify early predictors of lumbar spine surgery within 3 years after occupational back injury. SUMMARY OF BACKGROUND DATA: Back injuries are the most prevalent occupational injury in the United States. Few prospective studies have examined early predictors of spine surgery after work-related back injury. METHODS: Using Disability Risk Identification Study Cohort (D-RISC) data, we examined the early predictors of lumbar spine surgery within 3 years among Washington State workers, with new workers compensation temporary total disability claims for back injuries. Baseline measures included worker-reported measures obtained approximately 3 weeks after claim submission. We used medical bill data to determine whether participants underwent surgery, covered by the claim, within 3 years. Baseline predictors (P < 0.10) of surgery in bivariate analyses were included in a multivariate logistic regression model predicting lumbar spine surgery. The area under the receiver operating characteristic curve of the model was used to determine the model's ability to identify correctly workers who underwent surgery. RESULTS: In the D-RISC sample of 1885 workers, 174 (9.2%) had a lumbar spine surgery within 3 years. Baseline variables associated with surgery (P < 0.05) in the multivariate model included higher Roland-Morris Disability Questionnaire scores, greater injury severity, and surgeon as first provider seen for the injury. Reduced odds of surgery were observed for those younger than 35 years, females, Hispanics, and those whose first provider was a chiropractor. Approximately 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor. The area under the receiver operating characteristic curve of the multivariate model was 0.93 (95% confidence interval, 0.92-0.95), indicating excellent ability to discriminate between workers who would versus would not have surgery. CONCLUSION: Baseline variables in multiple domains predicted lumbar spine surgery. There was a very strong association between surgery and first provider seen for the injury even after adjustment for other important variables.
Keywords
Back-injuries; Workers; Humans; Men; Women; Age-groups; Injuries; Etiology; Questionnaires; Models; Author Keywords: lumbar spine surgery; back injury; workers' compensation; predictors; prospective study
Contact
Benjamin J. Keeney, PhD, Department of Orthopaedics, Hinman Box 7541, Geisel School of Medicine at Dartmouth College, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH 03756
CODEN
SPINDD
Publication Date
20130515
Document Type
Journal Article
Email Address
Benjamin.J.Keeney@Dartmouth.edu
Funding Type
Grant
Fiscal Year
2013
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-R01-OH-004069; M122013
Issue of Publication
11
ISSN
0362-2436
Source Name
Spine
State
NH; WA; OH
Performing Organization
University of Washington
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