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Published on: September 13, 2020
Association Between Worker's Compensation Status and Outcomes for Surgical Treatment of Lateral Epicondylitis
Asher B Mirvish1, John R Fowler1
1Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA.
Purpose:
Evaluate for variation between patients undergoing surgery for lateral epicondylitis (LE) with and without worker's compensation (WC) coverage.
Methods:
A retrospective review was performed on patients, identified by Current Procedural Terminology codes, who underwent LE surgery between 2008 and 2020. Following exclusions, there were 293 operative patients for LE, 34 of whom had WC coverage. Outcomes consisted of comparing before surgery and postoperative pain level reported by patient feedback during consultations, ability to perform job duties, and retaining employment. This study also assessed clinical workflow via time to surgery. Positive outcomes included having resolution or improvement in symptoms after surgery, returning to employment completely, and the ability to perform job duties appropriately. Negative outcomes included unchanged or worsened pain, incomplete return to work, loss of employment, and revisions. Patients were evaluated after surgery at approximately 2-week, 6-week, and 3-month milestones.
Results:
Of the 34 WC cases, 12 (35%) had a negative outcome, whether persistent pain, reassignment to permanent and stationary employment, or loss of employment. Twenty percent of WC patients versus 3.5% of non-worker's compensation (NWC) patients had unchanged symptoms. Twenty-five percent of WC patients returned to modified duty versus 7.3% of NWC. Two WC patients and one NWC patient lost their jobs. Patients on WC were more likely to have delays in time to surgery than NWC patients. Postoperative documentation reflected persistent epicondylitis as the reason for failure of complete return to work. By the 3-month postoperative consultation, 3% of patients without WC (NWC) had negative outcomes, whereas 20% of WC patients had a negative outcome. By the final consultation, 92% of NWC patients returned to work full duty, whereas 68% of WC patients were able to return to work full duty.
Conclusions:
Overall, only approximately two-thirds of patients undergoing LE surgery under a WC claim returned to work within 3 months of surgery, compared to 92% without a WC claim. WC patients had more frequent delays in time to surgery versus NWC patients.
Type Of Study/Level Of Evidence:
Prognostic IV.
