Prognostic Factors for Return to Work after Intervertebral Disc Displacement Surgery: A Historical Cohort Study in Indonesia

Background. Intervertebral Disc Displacement (IDD) is a prevalent condition in working-age individuals and the leading cause of occupational disability and early retirement. This condition may need interventional surgery. Successful return to work (RTW) is an important outcome following IDD surgery. Not returning to work after surgery has significant financial and social consequences for people and society.

Objective. This study aimed to investigate the proportion and time of successful RTW after IDD surgery and to evaluate the factors that may affect successful RTW after IDD surgery.

Methods. A historical cohort study was undertaken at a national referral hospital in Jakarta, Indonesia, by analyzing data from medical records from 2017 to 2022 on workers who underwent IDD surgery. We analyzed clinical conditions (pain severity after surgery, length of hospital stay, duration of IDD pain until surgery, type of surgery), occupational factors (job type and work support from the employer), and individual characteristics (age, gender, body mass index, education level, smoking habit) from medical records that may be associated with successful RTW. Successful RTW was defined as pain severity after surgery ≤4, no increase in pain intensity, no additional clinic visits other than those scheduled, and no need for increased medication dosage or type.

Results. Data were collected from 145 subjects. Female workers were a little more frequent. The median age of the subjects was 52 years old. The subjects had IDD pain until surgery for about 18 months, with a median postoperative pain level of 2 out of 10. There were 32% of subjects who underwent minimally invasive surgery. Around 59 subjects (40.7%) successfully returned to work within a median of 26 days after hospitalization. Age (p = 0.04), gender (p = 0.046), education level (p = 0.04), and type of surgery (p = 0.02) were all substantially associated with returning to work.

Conclusion. Less than 50% of workers who had undergone IDD surgery had successfully returned to work. Age, gender, education level, and type of surgery were the prognostic factors for successful RTW in the workers undergone IDD surgery. It is critical to create a return-towork strategy even before the patients undergo surgery.