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

Fujihara, Yuki M.D.; Shauver, Melissa J. M.P.H.; Lark, Meghan E. B.S.; Zhong, Lin M.D., M.P.H.; Chung, Kevin C. M.D., M.S.

Plastic & Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 923–933
doi: 10.1097/PRS.0000000000003154
Hand/Peripheral Nerve: Special Topic/Outcomes Article

Background: Patients who receive workers’ compensation often display worse surgical results, 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 whether the confounding effect differs based on how results are measured. The aim of this study was to determine whether these variations exist.

Methods: A search of full-length articles published between January 1, 1995, and December 31, 2015, was conducted using 3 online databases. The authors 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 them were retained for the meta-analysis. In the systematic review, 70 percent of studies found that patients receiving workers’ compensation had significantly worse postoperative results than uncompensated patients, whereas only 42 percent of studies that measured preoperative versus postoperative improvement were influenced by workers’ compensation. The meta-analysis found that uncompensated patients were more likely to experience improvement after surgery than patients receiving workers’ compensation (summary OR, 3.17; 95 percent CI, 2.47 to 4.08). A subgroup analysis demonstrated that functional measures, such as grip strength or nonunion, were least affected by workers’ compensation, compared with other outcome measures such as patient-reported outcomes questionnaires or time off work.

Conclusion: Potential bias introduced by workers’ compensation can be mitigated by evaluating surgical treatment of work-related upper extremity disorders using preoperative versus postoperative improvement or functional measures.

Ann Arbor, Mich.; and Nagoya, Japan

From the Section of Plastic and Reconstructive Surgery, University of Michigan Medical School; and the Department of Hand Surgery, Nagoya University Graduate School of Medicine.

Received for publication August 8, 2016; accepted October 17, 2016.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

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Kevin C. Chung, M.D., M.S., Section of Plastic Surgery, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109-5340,

©2017American Society of Plastic Surgeons