Return to Work Following Surgery for Lumbar Disc Herniation: Comparison of a Universal and Multitier Health Care System

INTRODUCTION: Canada has a universal health care system that is funded by the government. In contrast, the United States utilizes a combined public and private payer system where patients may directly access specialists. METHODS: Surgical lumbar disc herniation patients enrolled in the Canadian Spine Outcome Research Network (CSORN) prospective multicenter registry and were compared with the surgical cohort enrolled in the Spine Patients Outcome Research Trial (SPORT) study.Patient reported outcomes (PROs) and return to work were compared at 3 months and 1 year post-operatively were analyzed. RESULTS: The CSORN cohort consisted of 157 patients and the SPORT cohort was made up of 397 patients that were actively working at the time of surgery. The rate of depression (9.1% vs. 16.5%, p = 0.016) and symptom duration greater than 6 months were higher in the CSORN cohort (23.4% vs. 73.2%, p < 0.0001). 100% of the CSORN cohort had public insurance compared to 1% in the SPORT cohort (p < 0.001) and patients in the CSORN group were more likely to have compensation claims (17.8% vs. 9.1%, p = 0.0049). CSORN patients had better baseline ODI and SF36/12-PCS scores (ODI: 50.9 ± 19.7 vs. 45.8 ± 14.9, p = 0.0031; SF36/12 PCS: 29.9 ± 7.9 vs. 35.7 ± 7.4, p < 0.001). At 3 months post-operatively the rate of patients that had returned to work was significantly lower in the CSORN cohort (47.8% vs. 72.8%, p < 0.0001), but was not different at 12-months post-operatively (86.7% vs. 91.6%, p = 0.11). Membership in the CSORN cohort and compensation claims were significant independent predictors of not returning to work at 3-months post-operatively on multivariable logistic regression (OR 0.16, 95% CI 0.09-0.29, p < 0.001; OR 0.47, 95% CI 0.26-0.85, p = 0.012). CONCLUSION: Patients undergoing surgical treatment for lumbar disc herniation in Canada (CSORN cohort) had a lower rate of return to work at 3 months but not 1 year post-operatively compared to the United States cohort (SPORT) despite better disability scores prior to surgery.