These authors sought to determine: 1) the extent to which patient-reported outcomes are impacted by WC status in comparison to patients covered by other types of insurance, 2) which factors are predictive of a successful outcome of shoulder arthroplasty as defined by improvement exceeding the minimal clinically important difference (MCID), 3) the ability of WC patients to return to their presurgical occupation after arthroplasty.
They identified 677 patients who underwent primary anatomic shoulder arthroplasty with a minimum 2-year follow-up, 39 of whom had WC insurance. These patients were compared to a matched cohort of 78 patients not having WC insurance. Two non-WC patients were matched to every WC patient based on similar age, sex, ASA class, history of prior surgery, smoking status, type of procedure, preoperative SST, and preoperative SANE scores.
Jobs that required medium (9.1 to 22.7 kilograms or 20 to 50 pounds of force occasionally), heavy (22.7 to 45.4 kilograms or 50 to 100 pounds of force occasionally), or very heavy (>45.4 kilograms or >100 pounds of force occasionally) physical demands were classified as physically-demanding, while jobs that required sedentary (less than 4.5 kilograms or 10 pounds of force occasionally) or light (4.5 to 9.1 kilograms or 10 to 20 pounds of force occasionally) physical demands were classified as non-physically-demanding.
21% of patients covered by WC insurance had lawyer involvement in contrast to 1% of non-WC patients
Success, defined as improvement beyond MCID, occurred in a significantly lower proportion of workers’ compensation patients compared to non-workers’ compensation patients (64% vs. 94%, p<0.001). WC patients had lower postoperative scores and a higher percentage of revision surgery.
Among WC patients, older age (p=0.010) and a higher preoperative SF-36 role physical domain score (a measure of the patient’s perceived limitations in routine activities) (p=0.007) were associated with improvement beyond the MCID.
Among WC patients, the patients most likely to achieve significant improvement were more likely to be younger, male, have a diagnosis of osteoarthritis, have a lower preoperative SST score and have higher SF-36 scores in "role physical', "mental component summary" and "physical component summary".
A significantly lower percentage of patients with physically demanding jobs returned to previous occupation compared to patients with non physically demanding jobs (13% vs. 73%, p=0.001).
Comment: This article points out that patients on WC insurance and having shoulder arthroplasty have substantially different preoperative characteristics than those not on WC insurance.
The data suggest that surgeons should be cautious about predicting a successful return to work for patients on WC insurance, especially for those patients with physically demanding jobs and those with low levels of physical function prior to surgery.
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