Lighting Talk Sydney Spinal Symposium 2024

Influence of workers’ compensation on outcomes in spinal endoscopic surgery. (#20)

Prashanth Rao 1 2 3 4 , Gayani Petersingham 4 , Dineth Fernando 1
  1. Spine Service, University of New South Wales, Department of Orthopaedic Surgery, St George and Sutherland Clinical School, SYDNEY, NSW, Australia
  2. Department of Neurosurgery, Norwest Private Hospital, BELLA VISTA, NSW, Australia
  3. Department of Neurosurgery, Macquarie University Hospital, MACQUARIE PARK, NSW, Australia
  4. Brain and Spine Surgery, BELLA VISTA, NSW, Australia

Abstract
Purpose Workers’ compensation is associated with worse post-operative outcomes in spine surgery. However, there is not much data on endoscopic spine surgery. This retrospective study of prospectively collected data analyses the influence of Workers’ compensation (WC) on the outcomes of endoscopic spinal surgeries in an Australian single-centre Neurosurgical practice to explore this relationship.

Methods This retrospective analysis included 270 patients with spinal conditions who had undergone endoscopic surgery between August 2021 to June 2024. Comprehensive patient data, such as demographic information, preoperative clinical status, intraoperative details, clinical complications, and postoperative outcomes, were collected from electronic medical records. Measurable surgical outcomes include Visual Analogue Scale (VAS) leg pain scores, VAS back pain scores, Oswestry Disability Index (ODI), Roland‐Morris Disability Questionnaire (RMDQ) scores, and the Quality-of-life EuroQol-5 Dimensions Questionnaire (EQ5D) scores. These outcomes were assessed using Descriptive statistics, Estimation-Stats package, and Spearman’s rank correlations, considering a P-value < 0.05 as statistically significant.

Results The analysis revealed a significant negative correlation between WC status and 6–12week postoperative improvements in ODI (r= -.25, p=.017), RMDQ (r=-.29, p=.002), VAS Back (r = -.21, p=.017 and VAS Leg pain scores (r=-.36, p<0.001), indicating that WC status is associated with less postoperative improvement.  These were not reflected in EQ5D scores, where WC had no effect (p=.27). At 6-9 months, these negative correlations remained for VAS Back (r= -.31, p=.01), VAS Leg (-.47, p= 0.001) but disappeared for ODI (p=.8), RMDQ (p=.18) and EQ5D (p=.069). Despite variations in disability improvement, the WC group experienced pain relief postoperatively.

Conclusion This is the first study looking at the effect of WC status on endoscopy surgical outcomes. WC has a significant inverse relationship with short-term improvements in pain and disability except EQ5D5L following endoscopic spinal surgery. But this inverse relationship disappeared at medium term in disability while persisting in back and leg pain. These indicate the WC patients, in comparison to non-WC patients, experienced less improvement in pain in the short term and medium term however disability improvement is similar in medium term. Further data is needed to establish improvements in the long term.