273. Gender difference in return to work after spine surgery

BACKGROUND CONTEXT Work disability presents a major burden and stressor at the levels of the individual and society in general. Factors that inhibit or prevent return to work must continually be researched. PURPOSE A study was conducted to examine and define the rates of return to full-time employment for patients not involved in worker's compensation (WC) and to identify modifying factors thereof. STUDY DESIGN/SETTING A retrospective chart review with a prospective IRB approved telephone questionnaire designed to collect pre and postop work history was utilized. Multiple factors were examined that may affect the return to work (RTW) rate of a patient population working full time 3 months prior to surgery (including baseline data such as comorbidities, gender, surgical complexity, age, BMI, social history, ethnicity). PATIENT SAMPLE An IRB-approved retrospective chart review was performed on all surgical patients who underwent spinal surgery from December 2006 to January 2016 in two spinal surgeons’ practices. A total of 1,648 patients were identified with a minimum of 2-year follow-up. After reaching out to 1,088 sequential patients over a 2-year period, 394 called back. Of these, 325 consented to the questionnaire with 69 patients declining. OUTCOME MEASURES Factors examined to affect rate of return to work with 1 year were: procedure type, levels fused, ethnicity, gender, BMI, smoker status, alcohol consumption status, diabetes, heart disease, osteoporosis, anxiety, depression, DVT, previous spine surgery, IV antibiotics, intraoperative and postoperative complications, and infection. METHODS Subgroups within the patient sample showed no significant difference in male-female ratio. Prospective questionaire asked were: status before work, after work, when they returned full time and when RTW to the same job. Minimum phone follow-up was two years postoperatively. Baseline data (date of birth, gender, BMI, preoperative comorbidities, ethnicity, social history, surgery date, surgery type, levels fused, occupation) was obtained by chart review for these patients. The prospective data collecting pre- and postoperative work history along with the retrospective chart review data was analyzed looking for any trends in patients who were working full time 3 months preop and not returning to full time work within a year of surgical date. RESULTS No comorbidity or other correlative factors of RTW were detected. However, a significant difference of RTW rate was noticed between genders. Examining nonretired patients who reported full-time employment within 3 months of surgical intervention, 87 females and 94 males qualified. Only 60% of patients in the female group and 89% in the male group returned to full-time employment within one year. When subdivided by surgical complexity, in noncomplex cases, the rate of return to full-time employment was 59% for females, and 89% for males vs complex cases, where 64% of females and 90% for males returned to work full-time. Both analyses had a power of 99% with p-values less than .05. CONCLUSIONS Our data demonstrated that the return to work rate is significantly lower in female patients undergoing spine surgery, irrespective of the complexity of the surgery. This information may be helpful in pre- and postoperative management. This difference warrants discussion with patients preoperatively. Attitudes of employers towards employees after spinal surgery and the confidence of females after spinal surgery should be further investigated FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.