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Is Type of Compensation a Predictor of Outcome After Lumbar Fusion?
MedLine Citation:
PMID:  23080428     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
ABSTRACT: Study Design. Propensity-matched case control study.Objective. To examine the impact of compensation status on clinical outcomes following lumbar spine fusion.Summary of Background Data. Workers' compensation has been associated with inferior outcomes after treatment of low back pain. However, patients receiving other forms of compensation, such as long-term disability or government-supported insurance, have not been studied independently.Methods. Patients with complete preoperative and two-year postoperative data, including Oswestry Disability Index, SF-36 and numeric rating scales for back and leg pain, following 1- or 2-level posterolateral lumbar fusion from a single spine surgery practice were retrospectively identified. Fifty-nine patients ≤ 50 years old receiving disability-type compensation and 38 patients receiving workers' compensation were identified from 1144 patients with complete outcome measures. Propensity scoring was used to match cohorts not receiving compensation. Each group was matched for sex, age, smoking status, body mass index, surgical indication, number of levels fused and baseline outcome measures. 51 and 37 matched pairs were successfully identified for disability and workers' compensation cohorts, respectively.Results. Consistent with propensity-matching, no statistically significant difference between cohorts was observed for demographics and baseline outcome measures. At two-year follow-up, the disability compensation group demonstrated similar degrees of improvement for all outcome measures compared to its matched non-disability cohort; while the workers' compensation group demonstrated less improvement than its matched cohort.Conclusions. This study demonstrates a difference in outcomes after lumbar spinal fusion between long-term disability and workers' compensation populations. Although, these populations only achieve marginal improvement, it appears that the type of compensation status influences outcome. Workers' compensation has a clear, negative influence on outcome when compared to controls; while, well-selected patients receiving disability-type compensation seem more likely to benefit from lumbar fusion. Therefore surgeons and researchers alike should not include disability type compensation patients in the same cohort as patients on workers compensation patients.
Authors:
Jeffrey L Gum; Steven D Glassman; Leah Y Carreon
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-17
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor Ambulatory Care Building, Louisville, Kentucky 40202 2Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, Kentucky, 40202.
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