Predictors of back surgery after occupational back injury

Occupational back injuries are the most prevalent and costly occupational injury in the United States. Little is known about predictors of back surgery following an occupational back injury. We aimed to identify early predictors of back surgery within 3 years of filing a claim for a back injury. The Washington Workers' Compensation Disability Risk Identification Study Cohort (D-RISC) provided a population-based sample of workers with work loss due to recent back injuries, with information from administrative databases and worker interviews approximately 3 weeks after back injury on variables in eight domains, including sociodemographic, employment-related, pain and function, clinical status, health care, administrative/legal, health behavior, and psychological. We first identified baseline factors associated with (P < 0.10) surgery in bivariate analyses, then entered these in a multivariate logistic regression model predicting surgery (P < 0.05). 174 (9.2%) of 1,885 workers with recent back injuries had a back surgery within 3 years. Early predictors included suburban residence, not returning to work by the interview, more pain sites, higher Roland Disability Questionnaire scores, and greater injury severity. Workers under age 24, women, minorities, tobacco users, and those who first saw a chiropractor for their injury had lower odds of surgery. Early predictors of back surgery included variables from six domains. This information may be useful for matching patients in future comparative effectiveness studies of back surgery versus alternative treatments for occupational back pain and injury.