Paper #20 - Patient factors influencing return to work and cumulative financial claims after clavicle fractures in workers compensation cases

Abstract

Background: Workers compensation status is consistently cited as a predictor of poor outcome after orthopaedic procedures. This study analyzes a cohort of all workers compensation patients after surgical or non-operative treatment of clavicle fractures to identify factors that influence the time for return to work and total healthcare reimbursement claims, including a comparison of surgical and non-operative treatments. Operative treatment has been associated with faster time to boney union. We hypothesized that return to work for operative patients would be faster and the reimbursement claims for operative cases would be higher. Methods: The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes and Current Procedural Terminology (CPT) codes were used to retrospectively query the Workers' Compensation national database managed by University of Illinois, Chicago. Claims for clavicular fractures treated surgically and non-operatively were identified from 2003 to 2013. The outcomes of interest were the number of days for return to full work (RTW) following surgery and the total reimbursement for healthcare-related claims. The primary independent variable was treatment modality. Multivariate analysis was performed to control for relevant employee, employer and treatment covariates that were likely to confound associations. We used two-tailed hypothesis tests and P < .05 to indicate statistical significance. Averages are ± standard deviation. Results: There were 169 settled claims for clavicle fractures within the database. Only 20% (n = 34) of these claims related to surgical treatment, while 80% (n = 135) related to non-operative treatment. For claims with complete follow-up, the average time for RTW was 196 ± 287 days for surgical treatment, and 69 ± 94 days for non-operative treatment. The average healthcare claims reimbursed were $29,136 ± 26,998 for surgical management, compared to $8366 ± 14,758 for non-operative treatment. From multivariate RTW analysis, we did not find a significant difference between non-operative and surgical treatment groups in their time to RTW (P = .06) Claims from workers with one or more dependents (Reference Group [RG]: No dependents), from the West (RG: Midwest), from injuries related to athletics/Police/Firefighters (RG: Driving/flying/boating) were significant predicators of earlier RTW. Claims with a higher percentage of impairment, filing of a legal suit, and incident report only claims (RG: Employer's liability) were associated with later RTW. From multivariate reimbursement analysis, total healthcare reimbursement for claims with surgical treatment were 330% higher as compared to claims for non-operative treatment (P < .01). Claims with an associated legal suit, from working professionals (RG: Driving/Flying/Boating related injuries), from workers with at least 20 years of service (RG: < 10 years), and between 180 and 360 lost working days (RG: < 45 days) were predictors of higher healthcare claims. Injuries from pushing/pulling/lifting, and from falls (RG: Motor vehicle related injuries), and incident report only claims (RG: Employer's liability) were significant predictors of lower healthcare claim amount. Conclusion: Contrary to our hypothesis, the patients treated under workers compensation status for clavicle fractures return to work at roughly the same time whether they are treated surgically or non-operatively, when controlling for relevant covariates. Workers compensation patients treated with surgery accumulate significantly higher healthcare claims than those treated without surgery. Although many variables that independently influence return to work timing and cumulative health care claims in this study are non-modifiable, attempting to minimize legal suits may help expedite patients return to work. As the indications for operative treatment of clavicle fractures continues to be elucidated, non-operative treatment of fractures may help reduce overall financial burden in workers compensation patient population.