Fujihara Yuki, Shauver Melissa J, Lark Meghan E, Zhong Lin, Chung Kevin C
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.
Plast Reconstr Surg. 2017 Apr;139(4):923-933. doi: 10.1097/PRS.0000000000003154.
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.
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.
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.
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.
接受工伤赔偿的患者手术结果往往较差，如疼痛持续时间延长或功能能力下降。手术结果可通过多种调查、评估和测量来评估。目前尚不清楚混杂效应是否因结果测量方式的不同而有所差异。本研究的目的是确定是否存在这些差异。
使用3个在线数据库检索1995年1月1日至2015年12月31日期间发表的全文文章。作者针对每一项研究使用独特的纳入标准进行了系统评价和荟萃分析。
系统评价共纳入101篇文章；其中62篇被保留用于荟萃分析。在系统评价中，70%的研究发现接受工伤赔偿的患者术后结果明显比未获赔偿的患者差，而在测量术前与术后改善情况的研究中，只有42%受到工伤赔偿的影响。荟萃分析发现，未获赔偿的患者术后比接受工伤赔偿的患者更有可能出现改善（汇总比值比，3.17；95%置信区间，2.47至4.08）。亚组分析表明，与其他结果测量指标如患者报告的结果问卷或误工时间相比，握力或骨不连等功能测量指标受工伤赔偿的影响最小。
通过使用术前与术后改善情况或功能测量指标来评估与工作相关的上肢疾病的手术治疗，可以减轻工伤赔偿带来的潜在偏倚。
