Association between compensation status and outcomes in spine surgery: a meta-analysis of 31 studies

Abstract Background Context Numerous studies have demonstrated poorer outcomes in patients with Workers' compensation (WC) when compared with those without WC following treatment of various of health conditions, including spine disorders. It is thus important to consider compensation status when assessing treatment outcomes in spine surgery. However, reported strengths of association have varied significantly (1.31–7.22). Purpose The objective of this study was to evaluate the association of unsatisfactory outcomes on compensation status in spine surgery patients. Study Design/Setting A meta-analysis was performed. Patient Sample Patient sample is not applicable in this study. Outcome Measure Demographics, type of surgery, country, follow-up time, patient satisfaction, return to work and non-union events were the outcome measures. Methods Both prospective and retrospective studies that compared outcomes between compensated and non-compensated patients in spine surgery were included. Two independent investigators extracted outcome data. The meta-analysis was performed using Revman software. Random effects model was used to calculate risk ratio (RR, 95% confidence interval [CI]) for dichotomous variables. Results Thirty-one studies (13 prospective; 18 retrospective) with a total of 3,567 patients were included in the analysis. Follow-up time varied from 4 months to 10 years. Twelve studies involved only decompression; the rest were fusion. Overall RR of an unsatisfactory outcome was 2.12 [1.74, 2.58; p