These authors compared the complication rates and clinical outcomes after shoulder arthroplasty in workers' compensation (WC) patients and control non-WC patients.
They queried their institutional shoulder arthroplasty database for patients with minimum 2-year follow-up who underwent total shoulder arthroplasty, reverse total shoulder arthroplasty, or hemiarthroplasty. 45 WC patients were age and sex matched with 45 non-WC patients and retrospectively evaluated for complication rates, patient-reported outcomes, and range of motion.
The WC group had twice as high rate of prior surgery (82% vs 38%).
The WC group had an eight times higher reoperation rate (16% vs 2%)
The WC group had three times the rate of persistent pain at final follow-up (33% vs 11%).
The WC group had half the improvement for the SST (from 3.2 to 5.8) in comparison to the non WC group (4.3 to 9.7).
On multivariate regression controlling for other variables including number of prior surgical procedures, WC status remained associated with lower improvements in the Simple Shoulder Test scores, as well as a higher reoperation rate and a higher rate of persistent pain.
From these data it appears that the value of shoulder arthroplasty (improvement measured against cost, reoperations and complications) is less for patients on WC insurance. It appears that WC gets less return on its investment in shoulder arthroplasty than other forms of insurance. This study did not assess the success rate of returning patients to work for patients on WC and those not on WC; if shoulder arthroplasty were successful in getting a substantial number of patients back to work, this fact might tip the value equation.
A number of questions arise:
(1) Should these results influence the decision of WC to fund shoulder arthroplasty?
(2) Should these results influence the surgeon's decision to perform shoulder arthroplasty on WC funded patients?
(3) When a patient has chronic osteoarthritis with work-related aggravation, to what degree should WC insurance be fiscally responsible for the total cost of shoulder arthroplasty?
(4) Does WC insurance coverage of time off work disincent patients from "getting better"?
We do not know for sure how to answer these questions, but we must think about them in each case.
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How you can support progress in shoulder surgery
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Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
Use the "Search" box to the right to find other topics of interest to you.
How you can support progress in shoulder surgery
You may be interested in some of our most visited web pages arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
