Surgical treatment of patients with back problems covered by workers compensation versus those with other sources of payment

Study Design. The present study examines relationships between workers' compensation coverage and the surgical treatment of patients with low back problems. Objectives. To examine the mix of surgical procedures, reoperation rates, and resource use among patients receiving workers' compensation and those with other sources of payment. Summary of Background Data. There is evidence that patients with low back pain who receive workers' compensation have poorer clinical outcomes than other patients with back problems. Methods. The authors used data from Washington State's automated hospital discharge system for 1988 through 1991. The study group included 1502 patients receiving workers' compensation and 2674 patients not receiving workers' compensation. Results. If the patients were covered by workers' compensation, they were 1.37 times more likely to undergo surgery involving fusion (95% confidence interval, 1.04-1.80) and almost twice as likely to have a subsequent reoperation within 3 years of the index surgery (odds ratio, 1.80; 95% confidence interval, 1.50-2.15). Conclusions. In Washington state, patients receiving workers' compensation have higher rates of low back fusion surgery and reoperations than other patients.