Predictors of Vocational Prognosis After Herniated Lumbar Disc A Two-Year Follow-Up Study of 2039 Patients Diagnosed at Hospital
Predictors of Vocational Prognosis After Herniated Lumbar Disc A Two-Year Follow-Up Study of 2039 Patients Diagnosed at Hospital
复制标题
DOI：
10.1097/brs.0b013e3181ef6243
复制
发表时间：
2011-05-20
期刊：
影响因子：
3
通讯作者：
Svendsen, Susanne Wulff
中科院分区：
文献类型：
--
作者：
Jensen, Lone Donbaek;Frost, Poul;Svendsen, Susanne Wulff
研究设计。一项注册研究，随访2年。目的：确定医院接触治疗腰椎间盘突出症(HLD)后职业预后不良的预测因素。住院确诊的肝豆状核变性患者的职业预后信息很少。我们跟踪了2001年至2005年在丹麦一所大学医院被诊断为HLD的所有住院和门诊患者，这些患者符合丹麦国家公共转移支付登记(n=2039)中的劳动力市场资格。临床数据来自丹麦国家患者登记处。评估结果为不良的职业预后，定义为接触医院后第二年内工作时间少于40周。采用COX比例风险模型。41.8%的患者职业预后不佳。与学术工作和在医院接触HR 2.1(CI=1.9-2.5)前两年内工作少于40周相比，非熟练工作危险比(HR)2.1(95%可信区间[CI]=1.5-2.8)、熟练工作HR 1.9(CI=1.3-2.7)和半学术工作HR 1.5(CI=1.1-2.0)与结果相关。与非手术治疗相比，进一步的不良预后因素是单纯腰椎融合术HR 1.4(CI=1.1~1.8)和联合腰椎间融合术HR 1.6(CI=1.2~2.2)，丹麦以外的种族HR 1.55(CI=1.2~1.8)，女性HR 1.2(CI=1.1~1.4)。椎间盘摘除、年龄和纳入年与结果无关。HLD患者在医院接触后职业预后不良的风险很大。非学术工作和在医院接触前第二年内工作少于40周是最强烈的预后因素，但仅有腰椎融合术和与椎间盘切除、种族和性别相结合也有负面影响。似乎有必要针对这些患者类别采取行动，以避免长期病假和过早退出劳动力市场。
Study Design. A register study with 2 years of follow up.Objective. To identify predictors of an unfavorable vocational prognosis after hospital contact for herniated lumbar disc (HLD).Summary of Background Data. There is sparse information about vocational prognosis among HLD patients diagnosed at hospital.Methods. We followed all in-and outpatients diagnosed with HLD at a Danish University Hospital 2001 to 2005 eligible for the labor market in the Danish National Register on Public Transfer Payments (n = 2039). Clinical data were obtained from the Danish National Patient Register. The outcome measure was unfavorable vocational prognosis defined as less than 40 weeks of employment within the second year after hospital contact. Cox proportional hazards models were used.Results. Altogether 41.8% had an unfavorable vocational prognosis. The outcome was associated with unskilled work Hazard Ratio (HR) 2.1 (95% confidence interval [CI] = 1.5-2.8), skilled work HR 1.9 (CI = 1.3-2.7), and semi academic work HR 1.5 (CI = 1.1-2.0) as compared with academic work and less than 40 weeks of employment within year two before hospital contact HR 2.1 (CI = 1.9-2.5). Further negative prognostic factors were lumbar fusion alone HR 1.4 (CI = 1.1-1.8) and in combination with discectomy HR 1.6 (CI = 1.2-2.2) as compared with nonsurgical treatment, ethnicity other than Danish HR 1.55 (CI = 1.2-1.8), and female gender HR 1.2 (CI = 1.1-1.4). Discectomy, age, and year of inclusion were not associated with the outcome.Conclusion. The risk of an unfavorable vocational prognosis after hospital contact for HLD was substantial. Nonacademic work and less than 40 weeks of employment within year two before hospital contact were the strongest prognostic factors, but also lumbar fusion alone and in combination with discectomy, ethnicity, and gender had a negative influence. There seems to be a need for actions addressing these patient categories to avoid long-term sick leave and premature withdrawal from the labor market.