Factors Associated with Return-to-Work After Anterior Cervical Discectomy and Fusion in a Workers’ Compensation Setting: A Retrospective Cohort Study

Abstract

Background: Cervical radiculopathy can lead to significant work disability, particularly in workers’ compensation populations. Identifying factors associated with delayed return to work (RTW) may help optimize postoperative management. Objective: To evaluate factors associated with prolonged time to RTW following anterior cervical discectomy and fusion. Methods: A retrospective cohort study was conducted, including active workers who underwent anterior cervical discectomy and fusion for cervical radiculopathy between December 2013 and March 2023. Disability periods were compared between patients managed pre- and postoperatively by spine surgeons versus non–spine specialists using independent samples t-tests. Logistic regression was used to estimate odds ratios (OR) for postoperative disability >100 days. Time to RTW was further analyzed using Kaplan–Meier survival curves and compared with the log-rank test. Results: Seventy-one patients were included (mean age 49.1 ± 7.7 years). Patients managed by spine surgeons had significantly shorter preoperative (15.6 ± 19.9 vs. 45.5 ± 66.9 days; p = 0.025), postoperative (80.4 ± 54.6 vs. 113.9 ± 65.6 days; p = 0.028), and total disability time (96.0 ± 59.3 vs. 159.4 ± 84.0 days; p < 0.001). Management by non–spine specialists was associated with increased odds of postoperative disability >100 days (OR 3.3, 95% CI 1.2-9.0; p = 0.039). Kaplan–Meier analysis demonstrated earlier RTW in patients managed by spine surgeons (log-rank p = 0.020). Conclusion: Management by spine surgeons was associated with shorter disability duration and earlier RTW.