Does Workers’ Compensation Status Affect Outcomes after Lumbar Spine Surgery? A Systematic Review and Meta-Analysis

Low back pain (LBP) is currently the leading cause of disability worldwide and the most common reason for workers’ compensation (WC) claims. Studies have demonstrated that receiving WC is associated with a negative prognosis following treatment for a vast range of health conditions. However, the impact of WC on outcomes after spine surgery is still controversial. The aim of this meta-analysis was to systematically review the literature and analyze the impact of compensation status on outcomes after lumbar spine surgery. A systematic search was performed on Medline, Scopus, CINAHL, EMBASE and CENTRAL databases. The review included studies of patients undergoing lumbar spine surgery in which compensation status was reported. Methodological quality was assessed through ROBINS-I and quality of evidence was estimated using the GRADE rating. A total of 26 studies with a total of 2668 patients were included in the analysis. WC patients had higher post-operative pain and disability, as well as lower satisfaction after surgery when compared to those without WC. Furthermore, WC patients demonstrated to have a delayed return to work. According to our results, compensation status is associated with poor outcomes after lumbar spine surgery. Contextualizing post-operative outcomes in clinical and work-related domains helps understand the multifactorial nature of the phenomenon.

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The Impact of Corticosteroid Injection Timing on Infection Rates Following Spine Surgery: A Systematic Review and Meta-Analysis

Global Spine Journal ◽

10.1177/21925682211026630 ◽

2021 ◽

pp. 219256822110266

Author(s):

Gregory S. Kazarian ◽

Michael E. Steinhaus ◽

Han Jo Kim

Keyword(s):

Systematic Review ◽

Lumbar Spine ◽

Spine Surgery ◽

Postoperative Infection ◽

Corticosteroid Injection ◽

Meta Analysis ◽

Significant Risk ◽

Lumbar Spine Surgery ◽

Injection Timing ◽

The Impact

Study Design/Setting: Systematic review/meta-analysis. Objectives: The objective of this review was to assess how the risk of infection following lumbar spine surgery varies as a function of the timing of preoperative corticosteroid spinal injections (CSIs). Methods: A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. PubMed and EMBASE databases were searched and data was pooled for meta-analysis. Results: Six studies were identified for inclusion. Two (33.3%) demonstrated a significant relationship between the timing of preoperative CSIs and the risk of postoperative infection, while 4 (66.7%) demonstrated no impact. A total of 2.5% (110/4,448) of patients who underwent CSI <1 month before surgery experienced a postoperative infection, as compared to 1.2% (1,466/120, 943) of controls, which was statistically significant (RR = 1.986 95% CI 1.202-3.282 P = 0.007). A total of 1.6% (25/1,600) of patients who underwent CSI 0-3 months before surgery experienced a postoperative infection, as compared to 1.6% (201/12, 845) of controls (RR = 0.887 95% CI 0.586-1.341, P = 0.569). A total of 1.1% (199/17 870) of patients who underwent CSI 3-6 months before surgery experienced a postoperative infection, as compared to 1.3% (1,382/102, 572) of controls (RR = 1.053 95% CI 0.704-1.575, P = 0.802). Differences in infection risk for 0-3 months and 3-6 months were not statistically significant. Conclusions: CSIs <1 month prior to lumbar spine surgery are a significant risk factor for infection, while CSIs beyond that point showed no such association. Surgeons should consider avoiding CSIs <1 month of the use of CSIs of the spine.

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Current Prehabilitation Programs Do Not Improve the Postoperative Outcomes of Patients Scheduled for Lumbar Spine Surgery: A Systematic Review With Meta-analysis

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2021.9748 ◽

2020 ◽

pp. 1-47

Author(s):

Esther R.C. Janssen ◽

Ilona M. Punt ◽

Michel J. Clemens ◽

Bart J. Staal ◽

Thomas J. Hoogeboom ◽

...

Keyword(s):

Systematic Review ◽

Lumbar Spine ◽

Spine Surgery ◽

Meta Analysis ◽

Postoperative Outcomes ◽

Lumbar Spine Surgery

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The impact of surgical wait time on patient-based outcomes in posterior lumbar spine surgery (by J. Braybrooke et al.)

European Spine Journal ◽

10.1007/s00586-007-0453-4 ◽

2007 ◽

Vol 16 (11) ◽

pp. 1840-1841 ◽

Cited By ~ 3

Author(s):

Brian J. C. Freeman

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Wait Time ◽

Lumbar Spine Surgery ◽

The Impact ◽

Surgical Wait Time

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Anterior lumbar spine surgery: a systematic review and meta-analysis of associated complications

The Spine Journal ◽

10.1016/j.spinee.2015.02.040 ◽

2015 ◽

Vol 15 (5) ◽

pp. 1118-1132 ◽

Cited By ~ 32

Author(s):

Dexter K. Bateman ◽

Paul W. Millhouse ◽

Niti Shahi ◽

Abhijeet B. Kadam ◽

Mitchell G. Maltenfort ◽

...

Keyword(s):

Systematic Review ◽

Lumbar Spine ◽

Spine Surgery ◽

Meta Analysis ◽

Lumbar Spine Surgery

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Impact of the Economic Downturn on Elective Lumbar Spine Surgery in the United States: A National Trend Analysis, 2003 to 2013

Global Spine Journal ◽

10.1177/2192568217694151 ◽

2017 ◽

Vol 7 (3) ◽

pp. 213-219 ◽

Cited By ~ 21

Author(s):

David N. Bernstein ◽

David Brodell ◽

Yue Li ◽

Paul T. Rubery ◽

Addisu Mesfin

Keyword(s):

United States ◽

Lumbar Spine ◽

Spine Surgery ◽

International Classification Of Diseases ◽

The United States ◽

Lumbar Spine Surgery ◽

Economic Downturn ◽

Classification Of Diseases ◽

Lumbar Spinal ◽

The Impact

Study Design: Retrospective database analysis. Objective: The impact of the 2008-2009 economic downtown on elective lumbar spine surgery is unknown. Our objective was to investigate the effect of the economic downturn on the overall trends of elective lumbar spine surgery in the United States. Methods: The Nationwide Inpatient Sample (NIS) was used in conjunction with US Census and macroeconomic data to determine historical trends. The economic downturn was defined as 2008 to 2009. Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), were used in order to identify appropriate procedures. Confidence intervals were determined using subgroup analysis techniques. Results: From 2003 to 2012, there was a 19.8% and 26.1% decrease in the number of lumbar discectomies and laminectomies, respectively. Over the same time period, there was a 56.4% increase in the number of lumbar spinal fusions. The trend of elective lumbar spine surgeries per 100 000 persons in the US population remained consistent from 2008 to 2009. The number of procedures decreased by 4.5% from 2010 to 2011, 7.6% from 2011 to 2012, and 3.1% from 2012 to 2013. The R2 value between the number of surgeries and the S&P 500 Index was statistically significant ( P ≤ .05). Conclusions: The economic downturn did not affect elective lumbar fusions, which increased in total from 2003 to 2013. The relationship between the S&P 500 Index and surgical trends suggests that during recessions, individuals may utilize other means, such as insurance, to cover procedural costs and reduce out-of-pocket expenditures, accounting for no impact of the economic downturn on surgical trends. These findings can assist multiple stakeholders in better understanding the interconnectedness of macroeconomics, policy, and elective lumbar spine surgery trends.

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Systematic review and meta-analysis of the clinical utility of Enhanced Recovery After Surgery pathways in adult spine surgery

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20795 ◽

2020 ◽

pp. 1-23

Author(s):

Zach Pennington ◽

Ethan Cottrill ◽

Daniel Lubelski ◽

Jeff Ehresman ◽

Nicholas Theodore ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Meta Analysis ◽

Lumbar Spine Surgery ◽

Complication Rates ◽

Protocol Implementation ◽

Eras Protocol ◽

Adult Spine

OBJECTIVESpine surgery has been identified as a significant source of healthcare expenditures in the United States. Prolonged hospitalization has been cited as one source of increased spending, and there has been drive from providers and payors alike to decrease inpatient stays. One strategy currently being explored is the use of Enhanced Recovery After Surgery (ERAS) protocols. Here, the authors review the literature on adult spine ERAS protocols, focusing on clinical benefits and cost reductions. They also conducted a quantitative meta-analysis examining the following: 1) length of stay (LOS), 2) complication rate, 3) wound infection rate, 4) 30-day readmission rate, and 5) 30-day reoperation rate.METHODSUsing the PRISMA guidelines, a search of the PubMed/Medline, Web of Science, Cochrane Reviews, Embase, CINAHL, and OVID Medline databases was conducted to identify all full-text articles in the English-language literature describing ERAS protocol implementation for adult spine surgery. A quantitative meta-analysis using random-effects modeling was performed for the identified clinical outcomes using studies that directly compared ERAS protocols with conventional care.RESULTSOf 950 articles reviewed, 34 were included in the qualitative analysis and 20 were included in the quantitative analysis. The most common protocol types were general spine surgery protocols and protocols for lumbar spine surgery patients. The most frequently cited benefits of ERAS protocols were shorter LOS (n = 12), lower postoperative pain scores (n = 6), and decreased complication rates (n = 4). The meta-analysis demonstrated shorter LOS for the general spine surgery (mean difference −1.22 days [95% CI −1.98 to −0.47]) and lumbar spine ERAS protocols (−1.53 days [95% CI −2.89 to −0.16]). Neither general nor lumbar spine protocols led to a significant difference in complication rates. Insufficient data existed to perform a meta-analysis of the differences in costs or postoperative narcotic use.CONCLUSIONSPresent data suggest that ERAS protocol implementation may reduce hospitalization time among adult spine surgery patients and may lead to reductions in complication rates when applied to specific populations. To generate high-quality evidence capable of supporting practice guidelines, though, additional controlled trials are necessary to validate these early findings in larger populations.

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