reports

Does surgical setting or wait-time incentive improve return to work following knee surgery among injured workers?

Final report to WorkSafeBC. Vancouver, BC, Canada: University of British Columbia.

University of British Columbia, Vancouver, BC, Canada; University Health, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Institute for Work & Health, Toronto, ON, Canada 

Introduction: In an effort to reduce surgery wait time and disability time for injured workers, WorkSafeBC (the Workers’ Compensation Board of British Columbia) pays higher fees for surgeries in private clinics as well as fees for surgeries performed within 21 days of surgical consult regardless of private or public setting. The purpose of this project was to investigate the effect of expedited status (yes versus no) and surgical setting (private clinic versus public hospital) on surgery wait time (defined as last surgical consult date to surgery date) and return-to-work time (defined as surgery date to first return-to-work date within the year).
Methods: A study sample of 1,380 injured workers with an accepted time-loss claim for a knee injury who underwent meniscectomy day surgery (surgery that does not require an overnight stay at the hospital or clinic) between 2001 and 2005 were identified from WorkSafeBC data and included in the analysis. The study sample included three groups: expedited, private clinic surgeries (n=574); expedited, public hospital surgeries (n=568); and non-expedited, public hospital surgeries (n=238). Descriptive statistics investigated differences in baseline characteristics and median differences in surgery wait time and return-to-work time, by surgical setting and expedited status. Quantile regression, adjusted for clustering at the level of the surgeon with 1000 bootstrap replications, investigated differences in the median surgery wait days and return-to-work days for the 25th, 50th and 75th percentiles of the distribution, adjusted for socio-demographic, occupational and co-morbidity variables.
Results: The three study groups defined by surgical setting and expedited status did not differ statistically by mean age at time of surgery, mean wage at time of injury, percentage women, or preexisting co-morbidities. The median, adjusted surgery wait was 22 and 24 calendar days for expedited public and private surgeries respectively, compared to 37 days for non-expedited public surgeries. The median, adjusted return-to-work time was 58 and 60 calendar days for public surgeries (non-expedited and expedited respectively), compared to 66 days for expedited private surgeries. In the quantile regression analysis, the median difference in surgery wait time was 12.5 and 14 days less for the expedited surgeries (private and public respectively) compared to the non-expedited surgeries among individuals in the 50th percentile of the distribution. The median difference in return-to-work time was 4 and 6 days more for expedited surgeries (public and private respectively) compared to the non-expedited public surgeries for individuals in the 50th percentile of the distribution.
Conclusion: The expedited fee paid by WorkSafeBC reduced the surgery wait time among injured workers undergoing meniscal knee surgery regardless of surgical setting, although the difference in surgery wait time was not as large as anticipated with a difference of approximately 2 work weeks between the expedited and non-expedited groups. Following surgery, there was no statistical difference in return-to-work time by expedited status or clinic setting, but the public non-expedited group tended to return earlier by about 1 work week. A reduction in total disability time for injured workers has relevance for quality of life measures, but the difference in surgery wait time does not appear to affect the return-to-work or recovery window following surgery. This present study was an epidemiological investigation of the effect surgical setting and incentive payment on wait times and return to work outcomes. Future research should focus on whether providing incentive fees to surgeons and funding surgeries in private clinics represents good economic value to WorkSafeBC compared to funding nonexpedited surgeries in public hospitals. Further, the added cost of surgeries performed in private clinics given equal or more favourable outcomes for surgeries performed in public hospitals also warrants future cost benefit analyses.