Musculoskeletal Surgeries Outcome by Surgical Setting and Expedited Status

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Musculoskeletal Surgeries Outcome by Surgical
Setting and Expedited Status 21st Annual
Occupational and Environmental Health Conference,
Semiahmoo, January 8-9, 2009 Chris McLeod, Eric
Lorenz, Jonathan Fan, Ronita Nath, Mieke Koehoorn
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Research Opportunity

• WorkSafeBC is able to expedite diagnostic
  surgical procedures through private clinics
• Starting in 1996 for private clinics, 2001 for
  expedited procedures
• Never been evaluated criticized by Auditor
  General of BC
• Comparison of surgical population in private vs.
  public setting and expedited vs. non expedited

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Time off work matters!

• The longer a worker is off work, the less likely
  they are to return to work
• At 6 months, 50 fail to RTW
• At 12 months, 80 fail to RTW
• At 24 months, 90 fail to RTW

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Research Question

• Do surgical setting and expedited
• status matter?

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Methods Summary

• Study Population
• - Retrospective cohort design
• - Individuals in WorkSafeBC database coded
  for either a knee meniscectomy or knee meniscal
  repair between Jan. 2001 and Dec. 2005
• - Working age population (age 15 to 64)
• - Individuals are claim/injury free for at
  least one year prior to start of follow-up
• - Individuals have a time loss claim
• - Individuals underwent a day surgery procedure

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Defining wait times and outcomes
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Methods Summary

• Analyses
• Descriptive statistics
• Compared baseline characteristics of the three
  study groups (private expedited, public
  expedited, and public non-expedited)
• Quantile (median) regression models
• Examined association of covariates and outcomes
  (wait times and time to return-to-work)
• Focus is on median days
• Estimates also provided for 25th, 75th
  percentiles
• Age, gender, and wage retained in multivariate
  models

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Methods

• Study population
• N 1474 individuals

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Meniscal surgeries by surgical setting and
expedited status
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Patient characteristics by surgical setting and
expedited status, with 95 confidence intervals
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Patient characteristics by surgical setting and
expedited status, with 95 confidence intervals
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Results
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Results

• Specialist Consult Wait Time
• Referral Date ? (Last) Specialist Consult Date
• Median Days (with 25th and 75th percentiles)

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Results

• Surgery Wait Time
• (Last) Specialist Consult Date ? Surgery Date
• Median Days (with 25th and 75th percentiles)

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Results

• Time to Return to Work
• Surgery Date ? Return to Work Date
• Median Days (with 25th and 75th percentiles)

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Patient characteristics by health authority
region, with 95 confidence intervals
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Patient characteristics by health authority
region, with 95 confidence intervals
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Results

• Adjusted median days by health authority region

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Results

• Adjusted median days by health authority region

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Results

• Adjusted median days by health authority region

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Results

• Specialist Consult Wait Time (Referral Date ?
  (Last) Specialist Consult Date)
• Quantile regression coefficients (days, with 95
  confidence intervals)
• Variables included in model (coefficients not
  shown) gender, age, wage, and health authority

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Results

• Surgical Wait Time ((Last) Specialist Consult
  Date ? Surgery Date)
• Quantile regression coefficients (days, with 95
  confidence intervals)
• Variables included in model (coefficients not
  shown) gender, age, wage, and health authority

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Results

• Time to Return-to-Work (Surgery Date ? Return to
  Work Date)
• Quantile regression coefficients (days, with 95
  confidence intervals)
• Variables included in model (coefficients not
  shown) gender, age, wage, osteoarthritis, ACL
  diagnosis, previous surgery, and health authority

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Results

• Specialist Consult Wait Time (Referral Date ?
  (Last) Specialist Consult Date)
• Quantile regression coefficients (median days,
  with 95 confidence intervals)
• Variables included in model (coefficients not
  shown) surgical setting/expedited status,
  gender, age, and wage

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Results

• Surgical Wait Time ((Last) Specialist Consult
  Date ? Surgery Date)
• Quantile regression coefficients (days, with 95
  confidence intervals)
• Variables included in model (coefficients not
  shown) surgical setting/expedited status,
  gender, age, and wage

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Results

• Time to Return-to-Work (Surgery Date ? Return to
  Work Date)
• Quantile regression coefficients (median days,
  with 95 confidence intervals)
• Variables included in model (not all coefficients
  shown) surgical setting/expedited status,
  gender, age, wage, osteoarthritis, ACL diagnosis,
  previous surgery, and health authority

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Results

• Time to Return-to-Work (Surgery Date ? Return to
  Work Date)
• Quantile regression coefficients (days, with 95
  confidence intervals)
• Variables included in model (coefficients not
  shown) surgical setting/expedited status,
  gender, age, wage, osteoarthritis, ACL diagnosis,
  and previous injury

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Thank you!

• WorkSafeBC
• Partnership
• Roberta Ellis
• Terry Bogyo
• Ed McCloskey
• Penny Lowe
• VSC staff
• Diana McKay
• Joey Hofmeister
• Andrew Montgomery
• Clinical Management
• Gord van der Eerden
• Dr. Don Graham

• Co-Investigators
• UBC
• Mieke Koehoorn
• Morris Barer
• Kim McGrail
• Chris McLeod
• Toronto Western Hospital
• Pierre Côté
• Institute for Work Health
• Sheilah Hogg-Johnson
• Research Staff
• Rahul Chhokar, Eric Lorenz, Lillian Tamburic, Fan
  Xu, Jonathan Fan, Ronita Nath

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More Information

• On the Web
• www.chspr.ubc.ca/research/worksafebcWorkSafeBC
  resquery_at_worksafebc.comThe University of
  British ColumbiaChris McLeodMieke Koehoorn