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Comparing shoulder surgery outcomes in workers' compensation versus nonworkers' compensation patients: a
Tarishi Parmar1, Mohammad Daher1, Nazanin Kermanshahi2
1Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA.
Background:
Orthopedic surgeries for workers' compensation (WC) patients often yield worse outcomes compared to non-WC (NWC) patients. This includes longer recoveries, more complications, and delayed return to work, especially in shoulder surgeries, where WC patients show poorer functional outcomes and lower satisfaction. Since the last review in 2007, new studies on WC as an outcome predictor for shoulder surgeries have emerged, yet findings are scattered. This paper provides a comprehensive review and meta-analysis of studies published from 1988 to August 2024 on shoulder surgery outcomes in WC vs. NWC patients.
Methods:
A systematic review and meta-analysis were conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, and Google Scholar were searched using terms related to WC and shoulder surgeries, including "arthroscopy," "cuff tear," "biceps tenodesis," "subacromial decompression," "labral tear," "arthroplasty," and others. Eligible studies reported comparative outcomes for WC and NWC patients undergoing shoulder procedures. Data on patient characteristics, surgical techniques, outcomes, and complication rates were extracted. Two independent researchers assessed study quality and risk of bias, with disagreements resolved by consensus.
Results:
Among 827 studies searched, 28 met inclusion criteria, involving 2676 patients (942 WC, 1734 NWC). American Shoulder and Elbow Surgeons scores showed no significant difference at ≤1 year (mean difference [MD], -12.40; P = .08), but NWC patients demonstrated greater improvement at >1 year (MD, -18.91; P = .0005). Visual analog scale scores improved more in NWC patients within the first year (MD, 0.69; P < .00001), with no significant difference afterward (MD, 1.26; P = 2.28). Simple Shoulder Test scores favored NWC patients (MD, -1.03; P < .00001). NWC patients had significantly fewer complications (MD, 5.02; P < .00001), while revision rates and return to work status showed no significant differences (MD, 1.31; P = .33; MD, 0.49; P = .22).
Conclusion:
This meta-analysis examines shoulder surgery outcomes for WC vs. NWC patients, finding that WC patients experience worse long-term American Shoulder and Elbow Surgeons and Simple Shoulder Test scores and more complications, though revision rates and satisfaction are similar. These results underscore the need for tailored rehabilitation and support to improve WC patient recovery and guide health care providers in setting realistic expectations.
