A Review of a Workers’ Compensation Database 2003 to 2013: Patient Factors Influencing Return to Work and Cumulative Financial Claims After Rotator Cuff Repair in Geriatric Workers’ Compensation Cases

Abstract

Background:Workers’ compensation status is associated with poor outcomes after rotator cuff repair surgery. The purpose of this study was to analyze a database of geriatric workers’ compensation patients after surgical repair of the rotator cuff and identify both medical and nonmedical patient factors that influence the time it takes for them to return to work at full duty, including a comparison of arthroscopic and open techniques.Methods:An all workers’ compensation database was queried for rotator cuff claims that were surgically managed using arthroscopic, open, or both approaches from 2003 to 2013 in patients aged ≥60. Primary outcomes were the number of days for return to full work (RTW) following surgery and the total reimbursement for health care. Multivariate analysis was performed, and data are presented as average ± standard deviation.Results:The database yielded 1903 claims for surgically treated rotator cuff conditions (arthroscopic n = 935; open n = 926; both n = 42). In multivariate RTW analyses, we did not find a significant difference between groups (RTW in days was 153 ± 134 for arthroscopy [P = .81], 160 ± 160 for open [Ref], and 140 ± 82 days for both [P = .75]). However, multivariate analysis of reimbursement claims found arthroscopic surgery claims to be 13% higher compared to claims for open surgery only (US $29 986 ± 16 259 for arthroscopy vs US $26 495 ± 13 186 for open, P < .001). Patients aged ≥65 had more medical expenses than patients aged 60 to 64 (P = .03). Potentially modifiable variables that significantly prolonged RTW timing and higher health-care claims included need for vocational rehabilitation services and filing of a legal suit.Conclusions:Return to full-duty work in geriatric workers’ compensation patients after rotator cuff repair takes about 5 months regardless of surgical approach and costs significantly more in patients aged ≥65. Arthroscopic repairs generated 13% more cumulative health-care costs than open surgery alone. More efficient vocational rehabilitation services and minimizing legal suits may help get patients back to work sooner and reduce overall costs.

Predictive factors for the duration until return to work after surgery for work‐related rotator cuff syndrome: A prospective study of 92 workers

“…According to our study, postoperative sick leave mean duration following rotator cuff surgery in various employee populations reaches up to 7.5 months 9,45 . Other works have reported longer sick leave durations, 7 up to 9.8 months, as well as shorter periods of 5 months 13,46 . According to the authors, the short duration reported by Bodin et al 6 could be explained by the low severity of cases in the population studied.…”

Return to Work After Primary Rotator Cuff Repair: A Systematic Review and Meta-analysis

“…After title and abstract screening, 17 full texts were reviewed for inclusion criteria. Of these, 2 were excluded as they did not separate return to work and return to sports activity 5,16 ; 2 reported only medical release to work 10,33 ; and 2 were excluded as they did not report rates of return to previous work. 31,34 Two additional investigations 17,26 found outside the initial search met inclusion criteria and were included in analysis.…”

Earlier Return to Light Duty Is Associated With Successful Return to Full Duty of Workers’ Compensation Patients Treated With Shoulder Arthroscopic Surgery

“…A variety of factors have been shown to be associated with worse outcomes among WC patients, such as active litigation and job demands. 13 , 15 , 25 , 26 , 27 Some places of employment offer alternative work environments including light-duty work offers to WC patients to help these patients RTW more quickly and improve outcomes. 21 , 22 However, there are still many places of employment that do not offer sufficient RTW options such as light duty or that only allow their WC patients to return to full duty.…”

“…1 They also report higher rates of pain and disability, including preoperatively. 1 When examining the link between RTW and shoulder surgery, Shields et al 15 found that the minimization of legal involvement and a more efficient rehabilitation during RTW may help patients RTW more quickly while reducing the overall health care costs.…”