The Impact of Employment Status on Post-Operative Outcomes of Cervical and Lumbar Spine Surgery

Introduction: Socioeconomic factors are increasingly recognized as significant determinants of post-operative outcomes, yet research in neurosurgery is scarce. This study assessed the impact of employment on recovery metrics, including pain improvement, hospital stay duration, and readmission rates following cervical and lumbar spine surgery.

Methods: Using data from two Quality Outcomes Databases, we conducted a retrospective analysis of employment status in spinal surgery for patients below age 55. Key variables (age, BMI, surgery duration, hospital stay) were compared across groups. Pain improvement, hospital readmission, and return to operating room (OR) rates were evaluated.

Results: A total of 11,746 patients were included. In cervical spine surgery, unemployed patients experienced longer surgeries (110.7 vs 103.3 min, p< 0.01) and hospital stays (1.2 vs 0.8 days, p< 0.01) compared to employed patients. Unemployed patients demonstrated worse pain improvement at 3- and 12- months post-surgery (9.3 vs 12.2, p< 0.0184; 9.1 vs 12.5, p< 0.00013) and had higher rates of readmission (2.9% vs 1.4%, p< 0.04392) and return to OR (1.1% vs 0.8%, p< 0.001) compared to employed patients. Similar trends were seen with lumbar patients, with longer surgeries (131.6 vs 104.6 min, p< 0.001) and hospital stays (1.8 vs 1.0 days, p< 0.001), worse improvement at 3- and 12-months post-surgery for both leg (-38.1 vs -47.9, p< 0.001; -34.8 vs -46.6, p< 0.001) and back pain (-30.7 vs -36.1, p< 0.001; -27.6 vs -35.3, p< 0.001). Higher rates of readmission (8.1% vs 4.3%, p< 0.001) and return to OR (3.0% vs 1.7%, p< 0.001) were seen in unemployed lumbar patients compared to employed.

Conclusion : Employment status significantly impacts surgical duration and post-operative recovery following spine surgery. Unemployed patients experience worse pain outcomes, longer hospital stays, and more frequent readmissions. The underlying causes of these disparities highlight the necessity for further research.