Authors: Mohamad Bydon, MD, FAANS ; Clinton Devin, MD; Mohammed Ali Alvi, MD; Matthew McGirt, MD; Kristin Archer; Kevin Foley, MD; Praveen Mummaneni, MD; Erica Bisson, MD, MPH; John Knightly, MD; Christopher Shaffrey, MD; Anthony Asher, MD; Andrew Chan, MD (Rochester, MN)

Introduction: Neck pain is one of the most common causes of work-loss due to disability. Due to recent changes in healthcare policies, return to work (RTW) has been increasingly prioritized by physicians and hospitals to optimize healthcare delivery. In this manuscript, we utilized a national spine registry to identify clinical factors associated with RTW at 3 months among patients undergoing a cervical spine surgery. Methods: We queried the Quality-Outcomes-Database registry for preoperatively employed patients undergoing cervical spine surgery for degenerative spine disease. Multiple-imputations were used for missing values and multivariable (MV) logistic regression analysis was employed to identify factors associated with higher odds of returning to work. A nomogram was constructed using the results of the MV model. Results: A total of 4689 patients were analyzed, of which 82.2 %(n=3854) returned to work at 3-months postoperatively. Among previously employed and working patients, 88.3% (n=3443) patients returned to work compared to 53.3% (n=411) among those who were employed but not working (p<.001). On MV-analysis we found that patients who were less likely to RTW were older (Age>56-65:OR 0.69, 95% CI= 0.57-0.85,p<0.001;>65: OR 0.65, 95%CI= 0.43-0.97,p=0.02), were employed but on leave (OR 0.24, 95%CI: 0.20-0.29,p<0.001), were employed part-time (OR0.56, 95% CI=0.42-0.76, p<0.001), had a heavy (OR 0.42, 95% CI: 0.32- 0.54,p<0.001) or medium (OR 0.59, 95% CI:0.46-0.76,p<0.001) intensity occupation, had worker’s compensation (OR0.38, 95%CI:0.28-0.53,p<0.001),had a higher NDI score at baseline (OR 0.60, 95%CI:0.51-0.70,p=0.017), more likely to present with myelopathy (OR 0.52,95%CI:0.42-0.63,p< 0.001) and had more levels fused (3-5 levels:OR 0.46, 95%CI 0.35-0.61,p<0.001). We then constructed a nomogram to predict RTW which was found to have an area under the curve (AUC) of 0.812 and good validity. Conclusion: Multiple factors are predictive of 3-month RTW following cervical spine surgery including active employment, low-intensity occupation, and non-worker’s compensation status.