Clinical Outcomes for Workers' Compensation versus Commercially Insured Patients Following Ambulatory Lumbar Decompression: A Cohort Matched Analysis with Two-Year Follow-Up

Objective: To evaluate outcomes for workers' compensation (WC) versus commercially insured (CI) patients undergoing lumbar decompression (LD) at an ambulatory surgical center (ASC).

Methods: This is a retrospective cohort study utilizing propensity score matched groups. Patients undergoing elective LD at an ASC with two-year follow-up were identified and grouped based on insurance type (WC or CI). Other demographic, diagnostic, and patient-reported outcome (PRO) data were obtained as well. PROs included Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF), Visual Analog Scale-Back (VAS-B), VAS-Leg, Oswestry Disability Index (ODI), 12-Item Veterans Rand Physical Composite Score (VR-12 PCS), VR-12 Mental Composite Score (VR-12 MCS) and 9-Item Patient Health Questionnaire (PHQ-9). PRO scores were obtained preoperatively and up to two years postoperatively. Rates of minimum clinically important difference (MCID) were obtained. Multivariate regression was utilized to compare postoperative PROs.

Results: Following propensity score matching, 153 patients remained in the CI group and 71 were in the WC group. At baseline through one year postoperatively, WC patients reported worse ODI, PHQ-9, PROMIS-PF, VR-12 PCS, and VR-12 MCS (p≤0.041, all). At two years, WC patients reported similar outcomes as CI patients. WC patients reported significantly greater MCID achievement for PHQ-9 (73.1% versus 37.7% for CI patients, p=0.008).

Conclusion: WC patients report inferior pre- and postoperative outcomes in disability, mental health, and physical function compared to CI patients. However, WC patients were more likely to report clinically significant improvements in depressive burden. Surgeons can counsel WC patients on expected mental health improvements and recommend psychosocial and physical rehabilitation.