Dataset Information

Influence of compensation status on time off work after carpal tunnel release and rotator cuff surgery: a meta-analysis.

ABSTRACT:

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Background

The assessment of post-surgical outcomes among patients with Workers' Compensation is challenging as their results are typically worse compared to those who do not receive this compensation. These patients' time to return to work is a relevant outcome measure as it illustrates the economic and social implications of this phenomenon. In this meta-analysis we aimed to assess the influence of this factor, comparing compensated and non-compensated patients.

Findings

Two authors independently searched MEDLINE (Ovid), Embase (Ovid), CINAHL, Google Scholar, LILACS and the Cochrane Library and also searched for references from the retrieved studies. We aimed to find prospective studies that compared carpal tunnel release and elective rotator cuff surgery outcomes for Workers' Compensation patients versus their non-compensated counterparts. We assessed the studies' quality using the Guyatt & Busse Risk of Bias Tool. Data collection was performed to depict included studies characteristics and meta-analysis. Three studies were included in the review. Two of these studies assessed the outcomes following carpal tunnel release while the other focused on rotator cuff repair. The results demonstrated that time to return to work was longer for patients that were compensated and that there was a strong association between this outcome and compensation status - Standard Mean Difference, 1.35 (IC 95%; 0.91-1.80, p?ConclusionsThis study demonstrated that compensated patients have a longer return to work time following carpal tunnel release and elective rotator cuff surgery, compared to patients who did not receive compensation. Surgeons and health providers should be mindful of this phenomenon when evaluating the prognosis of a surgery for a patient receiving compensation for their condition.

Type of study/level of evidence

Meta-analysis of prospective Studies/ Level III.

SUBMITTER: de Moraes VY

PROVIDER: S-EPMC3548717 | biostudies-literature | 2013 Jan

REPOSITORIES: biostudies-literature

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Publications

Influence of compensation status on time off work after carpal tunnel release and rotator cuff surgery: a meta-analysis.

de Moraes Vinícius Ynoe VY Godin Katelyn K Dos Santos João Baptista Gomes JB Faloppa Flávio F Bhandari Mohit M Belloti João Carlos JC

Patient safety in surgery 20130102 1

<h4>Unlabelled</h4><h4>Background</h4>The assessment of post-surgical outcomes among patients with Workers' Compensation is challenging as their results are typically worse compared to those who do not receive this compensation. These patients' time to return to work is a relevant outcome measure as it illustrates the economic and social implications of this phenomenon. In this meta-analysis we aimed to assess the influence of this factor, comparing compensated and non-compensated patients.<h4>F ...[more]

PMID: 23281638

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Project description:BackgroundCarpal tunnel syndrome is a common nerve compression disorder which affects hand sensation and function. Carpal tunnel release surgery (CTR) is frequently performed to alleviate these symptoms. For many CTR patients, surgery occurs during their working lifetime, but there is currently no evidence-based guidance to inform clinicians or patients when it might be safe to return to different types of work afterwards. The aim of this qualitative study was to explore the return to work experiences of patients who had recently undergone CTR.MethodsSemi-structured 1:1 interviews were conducted with a subgroup of participants recruited to a multi-centre prospective cohort study. Interviewees were purposely selected to represent a range of demographic, clinical and occupational characteristics. All had recently undergone CTR and had returned to work. Interviews were audio recorded, transcribed verbatim and analysed using the framework method. Participants were recruited until data saturation was achieved.ResultsFourteen participants were interviewed: 11 women (median age 49 years, range 27-61) and 3 men (age range 51-68 years). Three key themes were identified. Theme 1 centred on the level of functional disability experienced immediately after surgery. There was an expectation that CTR would be a 'minor' procedure, but this did not match the participants' experiences. Theme 2 explored the desire for validation for the time away from work, with participants recalling a need to justify their work absence to themselves as well as to their employers. Theme 3 focused on the participants' reflections of handing their return to work and function, with many reporting uncertainties about what constituted appropriate activity loads and durations. There was a desire for specific information relating to individual work roles.ConclusionIndividual return to work decision-making was largely influenced by the recommendations received. According to the views of participants, clinicians may be able to prepare patients better pre-operatively, especially with respect to function in the immediate post-operative period and by providing return to work guidance that can be tailored for individual work roles.

Project description:BACKGROUND:The American Society of Anesthesiologists (ASA) Choosing Wisely Top-5 list of activities to avoid includes "Don't obtain baseline laboratory studies in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery - specifically complete blood count, basic or comprehensive metabolic panel, coagulation studies when blood loss (or fluid shifts) is/are expected to be minimal." Accordingly, we define low-value preoperative tests (LVTs) as those performed before minor surgery in patients without significant systemic disease. The objective of the current study was to examine the extent, variability, drivers, and costs of LVTs before carpal tunnel release (CTR) surgeries in the US Veterans Health Administration (VHA). METHODS:Using fiscal year (FY) 2015-2017 data derived from the VHA Corporate Data Warehouse (CDW), we determined the overall national and facility-level rates and associated costs of receiving any of 8 common LVTs in the 30 days before CTR in ASA physical status (PS) I-II patients. We also examined the patient, procedure, and facility factors associated with receiving ?1 LVT with mixed-effects logistic regression and the number of tests received with mixed-effects negative binomial regression. RESULTS:From FY15-17, 10,000 ASA class I-II patients received a CTR by 699 surgeons in 125 VHA facilities. Overall, 47.0% of patients had a CTR that was preceded by ?1 LVT, with substantial variability between facilities (range = 0%-100%; interquartile range = 36.3%), representing $339,717 in costs. Older age and female sex were associated with higher odds of receiving ?1 LVT. Local versus other modes of anesthesia were associated with lower odds of receiving ?1 LVT. Several facilities experienced large (>25%) increases or decreases from FY15 to FY17 in the proportion of patients receiving ?1 LVT. CONCLUSIONS:Counter to guidance from the ASA, we found that almost half of CTRs performed on ASA class I-II VHA patients were preceded by ?1 LVT. Although the total cost of these tests is relatively modest, CTR is just one of many low-risk procedures (eg, trigger finger release, cataract surgery) that may involve similar preoperative testing practices. These results will inform site selection for qualitative investigation of the drivers of low-value testing and the development of interventions to improve preoperative testing practice, especially in locations where rates of LVT are high.

Dataset Information

Influence of compensation status on time off work after carpal tunnel release and rotator cuff surgery: a meta-analysis.

Unlabelled

Background

Findings

Type of study/level of evidence

Publications

Influence of compensation status on time off work after carpal tunnel release and rotator cuff surgery: a meta-analysis.

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