Return to work and recovery time analysis after outpatient endoscopic lumbar transforaminal decompression surgery.

Background: This study aimed to analyze the return to work (RTW) and recovery time (RT) to narcotic independence following outpatient endoscopic decompression for contained lumbar herniated disc causing sciatica-type low back and leg pain.

Methods: A retrospective study of 442 patients with symptomatic contained lumbar herniated disc was treated with the transforaminal endoscopic decompression surgery. The mean follow-up was 33.5 months, ranging from 24 to 85 months. The patients' age ranged from 30 to 85 years, with a mean age of 40.9 years. Statistical analysis of pre- and postoperative VAS, Macnab outcomes, improvement of postoperative walking endurance was performed. RTW rates were correlated with the type of work as classified according to energy consumption per minute (Kcal/min) as , , and using guidelines adopted from the U.S. Department of Labor. Kaplan-Meier (KM) survival tables were calculated, and curves were plotted using IBM SPSS 25.0 to graphically illustrate the diverse RTW and RT dynamic when analyzed by the clinical outcome and the type of work performed by the patient preoperatively.

Results: (237/442) and (133/442) results were obtained in 83.7% (370/442) of patients. results were reported by 43 patients (9.7%), and results by 29 (6.6%), respectively. The mean preoperative VAS was 8.08. The mean postoperative VAS was significantly reduced to 2.55 (P<0.0001). The overall RTW rate was 92.5% (409/442). Patients performing (RTW rate =87.5%) and (RTW rate =86.0%) work had a lower RTW rate than patients who were performing jobs (370/442; RTW rate =95.8%). Preoperatively, only 31.7% (140/442) had unlimited walking endurance. Postoperative walking endurance was unlimited in 77.4% (342/442; P<0.0001). Another 20.4% (90/442) of patients had pain-free walking endurance up to one mile. K-M analysis showed an estimated median RTW of 6 days for , 9 days for , 17 days for , and 18 days for Macnab outcomes. RTW analysis by the type of work showed estimated median RTW of 20 days for patients in the , 13 days in the , and 6 days in the workgroup. The mean RT was 33.52 days in the , 19.17 days in the , and 9.86 days in the workgroup (P<0.0001). The mean RTW was 22.27 days (P=0.008) in the , 13.97 days (P=0.004) in the , and 7.58 days (P=0.004) in the workgroup. Postoperative irritation of the dorsal root ganglion (DRG) occurred in 68 of the 442 study patients (15.38%). DRG irritation delayed RTW to a mean of 18.94 days (P<0.0001) and RT to 15.31 days (P<0.001).

Conclusions: Patient RTW and RT data are "real-world" economic indicators of successful clinical outcomes with the lumbar endoscopic transforaminal decompression procedure and compare favorably to previously reported benchmarks for other types of translaminar surgeries. These median postoperative RTW and RT times with narcotic independence were on the order of 10 days or less in the vast majority of patients and outcomes (83.7%). The most relevant surgical predictor of delayed RTW and RT is a postoperative DRG irritation which predominantly affected patients adversely in the and workgroups. These RTW and RT data may assist in the management of return-to-work expectations with the spinal endoscopy procedure.