Surgical Complications and Return to Work Following Elective Spine Surgery: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study

Study Design: Cross-sectional analysis. Objective: To quantify the effect of postoperative adverse events on return to work (RTW) in a large cohort of patients undergoing elective spine surgery. Background: Return to work is a key outcome after spine surgery, which can be evaluated both in terms of occurrence and the time taken to return, with a positive RTW status and a shorter time to RTW viewed as favorable outcomes. RTW may be negatively affected by adverse events after surgery. Methods: The Michigan Spine Surgery Improvement Collaborative (MSSIC) registry was queried to identify patients who underwent elective spine surgery between January 1, 2017, and December 31, 2022, and who indicated that they planned to return to work after surgery. Two-level mixed-effects parametric survival-time models were used to examine associations between three potentially preventable adverse events after surgery—surgical site infection (SSI), hospital readmission, and urinary retention (UR)—and RTW. Time to RTW was estimated for patients with and without adverse events. Results: In the primary analysis including all patients, after adjusting for potential confounding factors, patients who had a SSI which did not lead to a readmission had a 31% increase in RTW time, patients who had SSI which also led to a readmission had a 148% increase in RTW time, and patients who were readmitted to hospitals within 30 days and 90 days had a 41% and 81% increase in RTW time, respectively. UR did not affect time to RTW significantly. SSI leading to readmission could have delayed RTW time by as much as more than seven months. Subgroup analyses showed a similar trend. Conclusions: This study shows an association between specific adverse events after spine surgery and RTW. Quality improvement initiatives designed to reduce rates of adverse events, if successful, could also increase the likelihood of RTW, and shorten the time to RTW among those patients who do return.