Sage Journals: Discover world-class research

Abstract

Aims: Scientific knowledge about risk factors for work disability in terms of long-term sickness absence and disability pension following lumbar spine decompression surgery remains insufficient. This study aimed to investigate the associations between socio-demographic, work-related, and medical characteristics with subsequent long-term sickness absence (>90 days) and disability pension for individuals who underwent lumbar spine decompression surgery. Methods: A prospective cohort study of all individuals aged 19–60 years with diagnosed dorsopathies, who underwent lumbar spine decompression surgery 2008–10 in Sweden (n=7373) was performed. Univariate and multivariate hazard ratios with 95% confidence intervals regarding long-term sickness absence and disability pension with a 3-year follow-up period were estimated by Cox proportional regression. Results: Low educational level, being a non-European immigrant and preoperative sickness absence were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2–3.8). Female sex was a risk factor for long-term sickness absence (hazard ratios: 1.3) whereas age >44 years and being a Nordic immigrant were risk factors for disability pension (hazard ratios: 1.9–2.6). Medical factors as common mental disorders, other mental disorders, prescribed psychiatric medication and somatic comorbidity were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2–3.4). A simultaneous lumbar fusion surgery and high preoperative pain severity were risk factors for long-term sickness absence (hazard ratios 1.2–1.8). Conclusions: To prevent long-term work disability after lumbar spine decompression surgery, specific focus is required on older and female patients, those with mental or somatic comorbidities, high levels of preoperative pain or sickness absence, with a simultaneous lumbar fusion surgery, a low educational level or a non-European immigrant background.

Keywords

Dorsopathies lumbar spine decompression surgery lumbar fusion surgery sick leave disability pension immigrants work disability

Get full access to this article

View all access options for this article.

References

Breivik

Collett

Ventafridda

et al . Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333.

Lurie

Tomkins-Lane

Management of lumbar spinal stenosis. BMJ. 2016;352:h6234.

Wynne-Jones

Cowen

Jordan

et al . Absence from work and return to work in people with back pain: A systematic review and meta-analysis. J Occup Environ Med. 2014;71(6):448–56.

Chou

Loeser

Owens

et al . Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: An evidence-based clinical practice guideline from the American Pain Society. Spine (Phila Pa 1976). 2009;34(10):1066–77.

Wilson

Roffey

Chow

et al . A systematic review of preoperative predictors for postoperative clinical outcomes following lumbar discectomy. Spine J. 2016;16(11):1413–22.

Manchikanti

Singh

Falco

FJE

et al . Epidemiology of low back pain in adults. Neuromod: Tech Neural Interface. 2014;17:3–10.

Steenstra

Verbeek

Heymans

et al . Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: A systematic review of the literature. J Occup Environ Med. 2005;62(12):851–60.

Werner

Cote

Low back pain and determinants of sickness absence. Euro J Gen Prac. 2009;15(2):74–9.

Loisel

Buchbinder

Hazard

et al . Prevention of work disability due to musculoskeletal disorders: The challenge of implementing evidence. J Occup Rehabil. 2005;15(4):507–24.

10.

Weinstein

Lurie

Tosteson

et al . Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2008;33(25):2789–800.

11.

WHO. International Statistical Classification of Diseases and Related Health Problems, 10 revision (ICD 10) [available from: http://www.who.int/classifications/icd/en/]. 2010.

12.

Newman

Lightfoot

Singleton

et al . Mental illness in Australian immigration detention centres. Lancet (London, England). 2010;375(9723):1344–5.

13.

Johansson

Lundberg

Return to work and adjustment latitude among employees on long-term sickness absence. J Occup Rehabil. 2006;16(2):185–95.

14.

Vaez

Rylander

Nygren

et al . Sickness absence and disability pension in a cohort of employees initially on long-term sick leave due to psychiatric disorders in Sweden. Soc Psychiatry Psychiatr Epidemiol. 2007;42(5):381–8.

15.

WHOCC. WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index 2016: WHOCC; [available from: http://www.whocc.no/atc_ddd_index/]. 2016.

16.

Ludvigsson

Andersson

Ekbom

et al . External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450.

17.

Fennema

Petrykiv

de Jonge

et al . Efficacy and safety of antidepressants as analgesics in chronic pain: A review. Euro Psychiatry. 2017;41 (Supplement):S234.

18.

Social insurance in figures, 2016. Social Insurance Agency. 2016.

19.

Jensen

Frost

Schiottz-Christensen

et al . Predictors of vocational prognosis after herniated lumbar disc: A two-year follow-up study of 2039 patients diagnosed at hospital. Spine. 2011;36(12):E791–7.

20.

Mittendorfer-Rutz

Dorner

TE.

Socio-economic factors associated with the 1year prevalence of severe pain and pain-related sickness absence in the Austrian population. Wien Klin Wochenschr. 2017.

21.

(Administration) RNSI. Regionala skillnader i sjukskrivning – hur ser de ut och vad beror de på? (Regional differences in sick leave - what do they look like and what are they due to?) [In Swedish with summary in English]. 2003.

22.

Osterberg

Gustafsson

Disability pension among immigrants in Sweden. Soc Sci Med (1982). 2006;63(3):805–16.

23.

Niederkrotenthaler

Wang

Helgesson

et al . Labour market marginalisation subsequent to suicide attempt in young migrants and native Swedes. Soc Psychiatry Psychiatr Epidemiol. 2017.

24.

Åslund

Nordström-Skans

Measuring conditional segregation: methods and empirical examples. IFAU working paper. 2005;2005:12.

25.

Lindstrom

Sundquist

Ethnic differences in daily smoking in Malmo, Sweden. Varying influence of psychosocial and economic factors. Eur J Public Health. 2002;12(4):287–94.

26.

Andersen

Christensen

Laursen

et al . Smoking as a predictor of negative outcome in lumbar spinal fusion. Spine. 2001;26(23):2623–8.

27.

Johansson

Helgesson

Lundberg

et al . Work and health among immigrants and native Swedes 1990–2008: A register-based study on hospitalization for common potentially work-related disorders, disability pension and mortality. BMC Pub Health. 2012;12:845.

28.

Pinheiro

Ferreira

Refshauge

et al . Symptoms of depression as a prognostic factor for low back pain: A systematic review. Spine J. 2016;16(1):105–16.

29.

Anderson

Haas

Percy

et al . Clinical depression is a strong predictor of poor lumbar fusion outcomes among workers’ compensation subjects. Spine. 2015;40(10):748–56.

30.

Dorner

Alexanderson

Svedberg

et al . Synergistic effect between back pain and common mental disorders and the risk of future disability pension: A nationwide study from Sweden. Psychol Med. 2015:1–12.

31.

Bair

Robinson

Eckert

et al . Impact of pain on depression treatment response in primary care. Psychosom Med. 2004;66(1):17–22.

32.

Bjorkenstam

Ljung

Burstrom

et al . Quality of medical care and excess mortality in psychiatric patients: A nationwide register-based study in Sweden. BMJ Open. 2012;2:e000778.

33.

Tye