Improving Productivity:
The Value of Herniated Disc Repair Surgery

Study Links Worker Productivity to Back Surgery

Back pain is a significant problem in America. In 2010, more than 10 million people experienced back pain. More than 200,000 of these patients are diagnosed with a herniated disc. Employees who experience back pain miss an average of 26 days of work and spend nearly 34 days in bed each year. While at work, back pain can affect productivity.

Past research has found herniated disc surgery to be an effective treatment option to ease the extreme back pain associated with herniation of a disc. However, until now, none of these studies accounted for lost productivity in the workplace. A new study, commissioned by AAOS and conducted by health economists, found surgery to be a cost-effective option for patients who used it, particularly because of its effect on productivity.

For example, terrible back pain following an injury on the field limited lacrosse coach Scott Hiller from coaching, and even made it difficult to perform everyday tasks such as walking around the house and holding his children. After trying non-operative treatments, Scott underwent disc herniation repair surgery and now is able to live a life without pain due to a herniated disc.

The study showed surgery can result in higher wages and, after recoverying from surgery, fewer missed workdays due to back pain. Specifically, patients receiving surgery earn an average of nearly $2,000 more and miss three fewer days per year than those who choose non-surgical treatments. Over a four-year period, those extra earnings average more than $7,000.

Furthermore, the study authors found these surgeries may result in savings to society when patients are relieved of their back pain over the long term.


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Frequently Asked Questions

  • What is an intervertebral disc and how is intervertebral disc herniation treated? Your spine is made up of 24 bones (vertebrae) that are stacked on top of one another. These bones connect to create a canal that protects the spinal cord. In between your vertebrae are flexible intervertebral discs that are flat and round, and about a half inch thick. They act as shock absorbers when you walk or run.In many cases, a herniated disc is related to the natural aging of your spine. In children and young adults, discs have high water content. As we get older, our discs begin to dry out and weaken. The discs begin to shrink and the spaces between the vertebrae get narrower. This normal aging process is called disc degeneration, and only a small percentage of patients with lumbar disk herniations require surgery. Spine surgery is typically recommended only after a period of nonsurgical treatment has not relieved painful symptoms.
  • What is the purpose of the research and why is it important to conduct this type of research? Every year, more than 200,000 people in the United States undergo surgery for intervertebral disc herniation (IDH), a debilitating condition associated with chronic pain and disability. Additionally, it can decrease productivity.  Although clinical studies have demonstrated that discectomy improves patient outcomes, including pain and physical function, compared to non-surgical treatment, few studies have comprehensively evaluated the economic impact of surgery. Given the increased societal focus on the cost effectiveness of health care, the American Academy of Orthopaedic Surgeons (AAOS) developed a study to estimate the economic value of surgery for IDH. Since surgery for IDH (discectomy) can impact people’s ability to work productively, successful treatment can potentially yield significant economic benefits to society.
  • What data were used to assess the economic value of hip fracture surgery and how was it analyzed? Based on a literature review, an analysis of Medicare claims data, and the input of a panel of clinical experts, AAOS created a Markov Decision Model, a standard predictive tool that accounts for various possible outcomes. Using this model, AAOS estimated the total societal savings associated with surgical treatment of lumbar disc herniation by comparing the direct medical costs, indirect costs, and Quality of Life Years (QALYs) for privately insured, working patients.
  • What did the research conclude? The estimated average annual earnings of patients who undergo surgery are $47,619, compared to $45,694 for those with non-surgical treatments, which means increased earnings of $1,925 for patients receiving surgery. After surgery, workers also miss 3 fewer days per year on average than non-surgery patients, although they miss an estimated 20 days immediately after surgery to recover. Disc herniation surgery is highly-cost effective and may yield net societal savings if the benefits of outpatient and inpatient surgery persist beyond 6 and 12 years, respectively.
  • How will the research be used in the future and what is its impact on health care costs? This is the first study to compare the effects of surgical and non-surgical treatment of IDH on a broad range of direct and indirect economic outcomes, including employment, earnings and missed work days.  It provides a foundation for assessing the value of procedures and health services, and in the future can be applied to other medical specialties beyond those mentioned above to ultimately reduce excess health care spending.