Adult spinal deformity surgery associated with increased productivity and decreased work and school absenteeism

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Wesley Durand

Adult spinal deformity (ASD) surgery is associated with increased productivity and decreased absenteeism from both work and school. These are the key findings from a recent retrospective cohort study, the findings of which were published by Wesley Durand (Johns Hopkins University, Baltimore, USA) et al in the journal Spine.

The study found that patients who underwent surgery for ASD exhibited an average increase in work/school productivity of 18.1% and decreased absenteeism of 1.1 per 90 days at two-year follow-up. In contrast, patients who were managed nonoperatively did not exhibit change from baseline.

Speaking to Spinal News International, Durand said: “This work adds to a growing body of literature attesting to the marked impact that adult spinal deformity surgery can have on a patient’s quality of life. We were very happy to be able to show that this benefit extends all the way from the individual to the potentially societal level.”

Only patients who were eligible for two-year follow-up were included in the study, while those with a history of previous spinal fusion were excluded.

The primary outcome measures were Scoliosis Research Society-22r score questions nine (What is your current level of work/school activity?) and 17 (In the last three months have you taken any days off of work, including household work, or school because of back pain?). A repeated measures mixed linear regression was used to analyse responses over time among patients managed operatively versus nonoperatively.

A total of 1,188 patients were analysed (66% managed operatively). At baseline, the mean percentage of activity at work/school was 56.4% (standard deviation [SD] 35.4%), and the mean days off from work/school over the past 90 days was 1.6 (SD 1.8).

Patients undergoing ASD surgery exhibited an 18.1% absolute increase in work/school productivity at 2-year follow-up compared with baseline (p<0.0001), while no significant change was observed for the nonoperative cohort (p>0.5).

Similarly, the operative cohort experienced 1.1 fewer absent days over the past 90 days at two years compared with baseline (p<0.0001), while the nonoperative cohort showed no such difference (p>0.3).

According to the researchers, these differences were largely preserved after stratifying by baseline employment status, age group, sagittal vertical axis, pelvic incidence minus lumbar lordosis, and deformity curve type.

“Given the age distribution of patients in this study, these findings should be interpreted as pertaining primarily to obligations at work or within the home. Further study of the direct and indirect economic benefits of ASD surgery to patients is warranted,” state the researchers.


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