161 Return to Work Following Surgery for Lumbar Disc Herniation: Comparison of a Universal and Multitier Health Care System
Bibliographic record
Abstract
INTRODUCTION: Canada has a universal health care system that is funded by the government. In contrast, the United States utilizes a combined public and private payer system where patients may directly access specialists. METHODS: Surgical lumbar disc herniation patients enrolled in the Canadian Spine Outcome Research Network (CSORN) prospective multicenter registry and were compared with the surgical cohort enrolled in the Spine Patients Outcome Research Trial (SPORT) study.Patient reported outcomes (PROs) and return to work were compared at 3 months and 1 year post-operatively were analyzed. RESULTS: The CSORN cohort consisted of 157 patients and the SPORT cohort was made up of 397 patients that were actively working at the time of surgery. The rate of depression (9.1% vs. 16.5%, p = 0.016) and symptom duration greater than 6 months were higher in the CSORN cohort (23.4% vs. 73.2%, p < 0.0001). 100% of the CSORN cohort had public insurance compared to 1% in the SPORT cohort (p < 0.001) and patients in the CSORN group were more likely to have compensation claims (17.8% vs. 9.1%, p = 0.0049). CSORN patients had better baseline ODI and SF36/12-PCS scores (ODI: 50.9 ± 19.7 vs. 45.8 ± 14.9, p = 0.0031; SF36/12 PCS: 29.9 ± 7.9 vs. 35.7 ± 7.4, p < 0.001). At 3 months post-operatively the rate of patients that had returned to work was significantly lower in the CSORN cohort (47.8% vs. 72.8%, p < 0.0001), but was not different at 12-months post-operatively (86.7% vs. 91.6%, p = 0.11). Membership in the CSORN cohort and compensation claims were significant independent predictors of not returning to work at 3-months post-operatively on multivariable logistic regression (OR 0.16, 95% CI 0.09-0.29, p < 0.001; OR 0.47, 95% CI 0.26-0.85, p = 0.012). CONCLUSION: Patients undergoing surgical treatment for lumbar disc herniation in Canada (CSORN cohort) had a lower rate of return to work at 3 months but not 1 year post-operatively compared to the United States cohort (SPORT) despite better disability scores prior to surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".