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The effect of workers' or third-party compensation on return to work after hand surgery
1St Luke's Hospital Hand Unit, Sydney, NSW.
Objectives:
To investigate the role of compensation in recovery from scaphoid internal fixation.
Design:
Retrospective review of patients who had had scaphoid internal fixations performed by one surgeon between 1 September 1981 and 31 December 1994 with a minimum follow-up of six months.
Setting:
Private practice of a specialist hand surgeon.
Patients:
202 patients who attended for the minimum of six months' follow-up, and for whom accurate details of return-to-work time were available.
Intervention:
Internal fixation of scaphoid fractures using the Herbert bone screw without postoperative immobilisation.
Main Outcome Measures:
Return-to-work time and compensation status.
Results:
Overall, patients receiving compensation took more than twice as long as privately insured individuals to return to work after scaphoid internal fixation (7.3 v. 3.3 weeks). There was no difference for clerical workers, but for manual workers compensable individuals took significantly longer (P < 0.001) to return to work. Compensation status did not affect bony union, postoperative wrist function, pain or patient satisfaction.
Conclusions:
Compensation encourages a slower return to work after surgery. The current compensation system could save millions of dollars each year by incorporating incentives to return to work without sacrificing good surgical results.