Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State.
Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State.
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DOI：
10.1097/brs.0b013e3182814ed5
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发表时间：
2013-05-15
期刊：
影响因子：
3
通讯作者：
Franklin GM
中科院分区：
文献类型：
--
作者：
Keeney BJ;Fulton-Kehoe D;Turner JA;Wickizer TM;Chan KC;Franklin GM
基于人群的前瞻性队列研究 旨在确定职业性背部损伤后 3 年内进行腰椎手术的早期预测因素 背部损伤是美国最常见的职业性损伤。对于职业性背部损伤后腰椎手术的预测因素知之甚少。使用残疾风险识别研究队列 (D-RISC) 数据，我们检查了华盛顿州工人因背部受伤而申请临时完全残疾赔偿的 3 年内进行腰椎手术的早期预测因素。基线措施包括提交索赔后大约 3 周获得的工人报告的措施。我们使用医疗账单数据来确定参与者是否在 3 年内接受了索赔所涵盖的手术。双变量分析中手术的基线预测因子（P < 0.10）包含在预测腰椎手术的多变量逻辑回归模型中。模型的受试者工作特征曲线下面积 (AUC) 用于确定模型正确识别接受手术的工人的能力。在 1,885 名工人的 D-RISC 样本中，174 名（9.2%）在 3 年内接受过腰椎手术。多变量模型中与手术相关的基线变量 (P < 0.05) 包括较高的罗兰残疾问卷评分、较大的损伤严重程度以及外科医生作为受伤的第一提供者。 35 岁以下的人、女性、西班牙裔以及首个提供者是脊椎按摩师的人的手术几率降低。第一次看外科医生的工人中有 42.7% 接受了手术，而看过脊椎按摩师的人中只有 1.5% 接受了手术。多变量模型的 AUC 为 0.93（95% CI 0.92-0.95），表明具有出色的区分愿意接受手术和不会接受手术的工人的能力。多个领域的基线变量预测腰椎手术。即使在调整其他重要变量之后，手术与第一次就诊的受伤提供者之间也存在非常强的关联。
Prospective population-based cohort study To identify early predictors of lumbar spine surgery within 3 years after occupational back injury Back injuries are the most prevalent occupational injury in the United States. Little is known about predictors of lumbar spine surgery following occupational back injury. Using Disability Risk Identification Study Cohort (D-RISC) data, we examined the early predictors of lumbar spine surgery within 3 years among Washington State workers with new worker’s compensation temporary total disability claims for back injuries. Baseline measures included worker-reported measures obtained approximately 3 weeks after claim submission. We used medical bill data to determine whether participants underwent surgery, covered by the claim, within 3 years. Baseline predictors (P < 0.10) of surgery in bivariate analyses were included in a multivariate logistic regression model predicting lumbar spine surgery. The model’s area under the receiver operating characteristic curve (AUC) was used to determine the model’s ability to identify correctly workers who underwent surgery. In the D-RISC sample of 1,885 workers, 174 (9.2%) had a lumbar spine surgery within 3 years. Baseline variables associated with surgery (P < 0.05) in the multivariate model included higher Roland Disability Questionnaire scores, greater injury severity, and surgeon as first provider seen for the injury. Reduced odds of surgery were observed for those under age 35, women, Hispanics, and those whose first provider was a chiropractor. 42.7% of workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor. The multivariate model’s AUC was 0.93 (95% CI 0.92–0.95), indicating excellent ability to discriminate between workers who would versus would not have surgery. Baseline variables in multiple domains predicted lumbar spine surgery. There was a very strong association between surgery and first provider seen for the injury, even after adjustment for other important variables.