Department of Orthopaedics, Mayo Clinic, Rochester, MN, USA.
Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY, USA.
J Shoulder Elbow Surg. 2020 Dec;29(12):2530-2537. doi: 10.1016/j.jse.2020.03.048. Epub 2020 Jun 9.
Although the literature on the association of workers' compensation (WC) status with negative outcomes after orthopedic surgery is extensive, there is a paucity of evidence on outcomes in WC recipients undergoing biceps tenodesis. We hypothesized that WC patients would report significantly worse outcomes postoperatively on patient-reported outcome measures (PROMs).
Functional and health-related quality-of-life PROMs and a visual analog scale score for pain were administered preoperatively and at 12 months postoperatively to consecutive patients undergoing isolated biceps tenodesis between 2014 and 2018 at our institution. Thirty-eight WC patients were matched 1:2 to non-WC patients by age, body mass index, and operative limb. The minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state were calculated for all patients via anchor- and distribution-based methods. Rates of achievement and the likelihood of achievement were determined.
All patients showed significant improvements in all outcome measures (P < .001). WC patients reported inferior postoperative scores on all PROMs examined. WC status significantly predicted a reduced likelihood of achieving substantial clinical benefit for the American Shoulder and Elbow Surgeons score (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.17-0.81; P = .01) and the patient acceptable symptom state (OR, 0.28; 95% CI, 0.12-0.65; P = .003) for the American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score (OR, 0.24; 95% CI, 0.10-0.61; P = .003), Constant-Murley Subjective Assessment (OR, 0.25; 95% CI, 0.08-0.77; P = .016), and visual analog scale pain score (OR, 0.27; 95% CI, 0.16-0.47; P < .001).
WC patients reported inferior scores on all postoperative PROMs and demonstrated lower odds of achieving substantial benefit and satisfaction regarding improvements in both function and pain compared with non-WC patients.
尽管有关工人赔偿（WC）状况与骨科手术后不良结局之间关联的文献很多，但关于 WC 接受者接受肱二头肌固定术的结果的证据很少。我们假设 WC 患者在术后报告的患者报告结局测量（PROM）会明显更差。
在 2014 年至 2018 年期间，我们机构对连续接受肱二头肌固定术的患者进行了术前和术后 12 个月的功能和健康相关生活质量 PROM 和疼痛视觉模拟评分（VAS）的评估。根据年龄、体重指数和手术肢体，38 名 WC 患者与非 WC 患者 1：2 匹配。通过基于锚点和分布的方法计算所有患者的最小临床重要差异、实质性临床获益和患者可接受的症状状态。确定达成率和达成的可能性。
所有患者在所有结局测量上均有显著改善（P<0.001）。WC 患者在所有接受检查的 PROM 上报告的术后评分较低。WC 状态显著预测美国肩肘外科评分（美国肩肘外科评分）的实质性临床获益的可能性降低（优势比[OR]，0.38；95%置信区间[CI]，0.17-0.81；P=0.01）和患者可接受的症状状态（OR，0.28；95%CI，0.12-0.65；P=0.003），用于美国肩肘外科评分（OR，0.24；95%CI，0.10-0.61；P=0.003），单一评估数字评估评分（OR，0.25；95%CI，0.08-0.77；P=0.016）和视觉模拟评分疼痛评分（OR，0.27；95%CI，0.16-0.47；P<0.001）。
与非 WC 患者相比，WC 患者在所有术后 PROM 上报告的评分较低，并且在功能和疼痛改善方面实现实质性获益和满意度的可能性较低。
