Impact of occupational characteristics on return to work for employed patients after elective cervical spine surgery
Authors: Chanbour Hani , Pennings Jacquelyn S. , Davidson Claudia , Croft Andrew J. , Chen Jeffrey W. , Vaughan Wilson E. , Khan Inamullah , Archer Kristin R. , Gardocki Raymond J. , Abtahi Amir M. , Stephens Byron F. , Zuckerman Scott L. 
Published: April 2024

OBJECTIVE
In a cohort of employed patients undergoing elective cervical spine surgery with an uncomplicated postoperative course, the authors sought to determine the demographic, functional, and occupational characteristics associated with return to work (RTW) following surgery.

METHODS
A retrospective cohort study of prospectively collected data was undertaken of patients undergoing elective cervical spine surgery for degenerative disease in the Quality Outcomes Database. Study inclusion criteria were: 1) employed prior to surgery and planned to RTW, 2) no unplanned readmissions, 3) achieved 30% improvement on the Neck Disability Index (NDI), and 4) were satisfied with the surgical outcome at 3 or 12 months postoperatively. A multivariable Cox regression model was built using demographic, functional, operative, and occupational characteristic to predict time to RTW.

RESULTS
Of 5110 included patients, 4788 (93.7%) returned to work within 12 months, with a median time of 35 (IQR 19–60) days. Patients who did RTW were significantly younger (51.3 ± 9.4 vs 55.8 ± 9.6 years, p < 0.001), more often underwent an anterior approach (85.8% vs 80.7%, p = 0.009), were significantly more privately insured (82.1% vs 64.0%, p < 0.001), and were less likely to have workers’ disability insurance (6.7% vs 14.6%, p < 0.001) compared with patients who did not RTW. On multivariable Cox regression, demographic factors associated with a longer RTW were older age (hazard ratio [HR] 0.99, 95% CI 0.99–1.00, p < 0.001) and Black race (HR 0.71, 95% CI 0.62–0.81, p < 0.001). Male sex was associated with a shorter RTW time (HR 1.19, 95% CI 1.11–1.26, p < 0.001). Regarding baseline functional status, worse preoperative NDI (HR 0.99, 95% CI 0.99–0.99, p < 0.001) was associated with a longer RTW, whereas the absence of myelopathy was associated with a shorter RTW (HR 1.17, 95% CI 1.09–1.25, p < 0.001). Having a sedentary (HR 1.81, 95% CI 1.65–1.99, p < 0.001), light-intensity (HR 1.60, 95% CI 1.45–1.76, p < 0.001), and medium-intensity (HR 1.11, 95% CI 1.01–1.22, p = 0.037) occupation was associated with a shorter RTW time compared with a heavy-intensity occupation at any time point. Heavy-intensity occupations were independently the strongest predictor of longer RTW. Similar predictors of shorter RTW were found in a subanalysis of occupation intensity and among operative approaches used.

CONCLUSIONS
Among patients undergoing elective degenerative cervical spine surgery who had favorable surgical outcomes and planned to RTW before surgery, 94% had a successful RTW. Age was the strongest predictor of lower odds of RTW. Regarding time to RTW, having a sedentary, light-intensity, or medium-intensity occupation was associated with a shorter RTW time compared with a heavy-intensity occupation. These findings highlight the importance of considering the demographic and occupational characteristics when predicting postoperative RTW in patients with satisfactory surgical outcomes.