The Effect of Workers’ Compensation on Outcome Measurement Methods after Upper Extremity Surgery: A Systematic Review and Meta-Analysis

Abstract

Background Patients who receive workers’ compensation (WC) often display worse surgical result such as prolonged pain or reduced functional ability. The outcomes of surgery can be assessed using a variety of surveys, assessments, and measurements. It is unknown if the confounding effect differs based on how results are measured. The aim of this study is to determine if these variations exist. Methods A search of full-length articles published between January 1, 1995 and December 31, 2015 was conducted using PubMed, Embase, and CINAHL. We performed a systematic review and meta-analysis using unique inclusion criteria for each. Results A total of 101 articles were included in the systematic review; 62 of those were retained for the meta-analysis. In the systematic review, 70% of studies found that patients receiving WC had significantly worse postoperative results than uncompensated patients, whereas only 42% of studies that measured pre- vs postoperative improvement were influenced by WC. The meta-analysis found that uncompensated patients were more likely to experience improvement after surgery than patients receiving WC (summary OR 3.17; 95% CI 2.47–4.08). A subgroup analysis demonstrated that functional measures, such as grip strength or nonunion, were least affected by WC, compared with other outcome measures such as patient-reported outcomes questionnaires or time off work. The specific disorder or the country of study did not change the effect of WC on results. Conclusion Potential bias introduced by WC can be mitigated by evaluating surgical treatment of work-related upper extremity disorders using pre- vs postoperative improvement or functional measures.

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