Spine surgery outcome in patients who sought compensation after a motor vehicle accident: a retrospective cohort study

BMC Surgery, Nov 2016

Background Back and neck pain are common after road traffic injury and are treated by spine surgery in some cases. This study aimed to describe the outcomes of spine surgery in people who made an insurance claim after road traffic accidents without an associated spinal fracture or dislocation. Methods This study was a retrospective cohort based on insurers’ data of Compulsory Third Party (CTP) claims. File audit and data extraction were undertaken using a study-specific proforma. Primary outcomes were ongoing pain and symptoms, complications, return to work and pre-injury duties, and ongoing treatment 2 years following spine surgery. Secondary outcomes were health care costs based on data provided by the insurers. Results After screening 766 files, 90 cases were included (female: 48; mean age: 46 years). Among the subjects who were working prior the injury, the rate of return to work was 37% and return to pre-injury duties was 23% 2 years following the surgery. The average number of appointments with health care professionals in the 1 year after surgery was 21, compared to 10 for the 1 year prior to surgery (p = 0.03). At 2 years following the initial surgery, 21% of claimants had undergone revision spine surgery; 68% reported ongoing back pain and 41% had ongoing radicular symptoms. The difference between costs 1 year before and after surgery (excluding surgical costs) was statistically significant (p = 0.04). Fusions surgery was associated with higher total costs than decompression alone. After adjusting for surgery type, lumbar surgery was associated with higher costs in the 1 year after surgery and total surgical costs compared to cervical surgery. Conclusions The majority of claimants continued having clinical symptoms, continued using health care and did not return to work despite undertaking spine surgery.

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Spine surgery outcome in patients who sought compensation after a motor vehicle accident: a retrospective cohort study

Sarrami et al. BMC Surgery Spine surgery outcome in patients who sought compensation after a motor vehicle accident: a retrospective cohort study Pooria Sarrami 0 1 Rafael Ekmejian 1 Justine M. Naylor 1 2 Joseph Descallar 1 3 Robindro Chatterji 1 Ian A. Harris 1 2 0 Institute of Trauma and Injury Management, Agency for Clinical Innovation , Level 4, Sage Building, 67 Albert Avenue, Chatswood, Sydney, NSW 2067 , Australia 1 South Western Sydney Clinical School , UNSW, Sydney , Australia 2 South Western Sydney Local Health District, Liverpool Hospital , Liverpool , Australia 3 Ingham Institute for Applied Medical Research , Sydney , Australia Background: Back and neck pain are common after road traffic injury and are treated by spine surgery in some cases. This study aimed to describe the outcomes of spine surgery in people who made an insurance claim after road traffic accidents without an associated spinal fracture or dislocation. Methods: This study was a retrospective cohort based on insurers' data of Compulsory Third Party (CTP) claims. File audit and data extraction were undertaken using a study-specific proforma. Primary outcomes were ongoing pain and symptoms, complications, return to work and pre-injury duties, and ongoing treatment 2 years following spine surgery. Secondary outcomes were health care costs based on data provided by the insurers. Results: After screening 766 files, 90 cases were included (female: 48; mean age: 46 years). Among the subjects who were working prior the injury, the rate of return to work was 37% and return to pre-injury duties was 23% 2 years following the surgery. The average number of appointments with health care professionals in the 1 year after surgery was 21, compared to 10 for the 1 year prior to surgery (p = 0.03). At 2 years following the initial surgery, 21% of claimants had undergone revision spine surgery; 68% reported ongoing back pain and 41% had ongoing radicular symptoms. The difference between costs 1 year before and after surgery (excluding surgical costs) was statistically significant (p = 0.04). Fusions surgery was associated with higher total costs than decompression alone. After adjusting for surgery type, lumbar surgery was associated with higher costs in the 1 year after surgery and total surgical costs compared to cervical surgery. Conclusions: The majority of claimants continued having clinical symptoms, continued using health care and did not return to work despite undertaking spine surgery. Spine surgery; Decompression; Clinical outcome; Road traffic accidents; Compensation - Background Road traffic crash casualties are estimated to cost $17b in Australia each year, with New South Wales (NSW) having the highest total cost compared to other states [1]. Among the annual cost of road traffic crash casualties, 56% are related to human costs, including: medical treatment and rehabilitation; long-term care; labour in the workplace and quality of life [1]. Back and neck pain are common after road traffic injury [2]. Recovery of back pain is lengthy and the median time to claim closure is reported to be 505 days [2]. Post-accident neck and back pain are also predictors of chronicity in whiplash after motor vehicle crashes [3–5]. A considerable number of patients who are involved in a road traffic accident will pursue a compensation claim, mostly through a Compulsory Third Party (CTP) scheme. In NSW, CTP insurance covers all persons involved in a motor vehicle crash on public roads who are not at fault. Surgery is a one of the treatments used for back pain [6–8] including following motor vehicle injury and surgery costs can be covered by the CTP scheme for such claimants. © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Emerging evidence suggests seeking compensation can be associated with poorer health outcomes [9]. A previous study retrospectively reviewed outcomes of spine surgery for patients without fracture or dislocation in an Australian worker’s compensation cohort. Data were collected from WorkCover NSW and insurer agents and it was found 77% of patients needed ongoing treatment 2 years post spine surgery [6]. However, there have been no reports on the outcome of patients who undergo spine surgery under CTP scheme after road traffic accidents. Therefore, this study aimed to explore the outcomes of such patients. Specifically, we aimed to determine rates of ongoing pain and symptoms, co (...truncated)


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Pooria Sarrami, Rafael Ekmejian, Justine Naylor, Joseph Descallar, Robindro Chatterji, Ian Harris. Spine surgery outcome in patients who sought compensation after a motor vehicle accident: a retrospective cohort study, BMC Surgery, 2016, pp. 76, 16, DOI: 10.1186/s12893-016-0192-8