Shoulder surgery in workers’ compensation patients

What the figures say!

John NorthMichael Francis

Declaration

John NorthChairman, Orthopaedic Assessment Tribunal

Michael FrancisSecretary, Medical Assessment Tribunals (Q-COMP)

Data supplied by Q-COMP

HypothesisSurgery for ‘adhesive capsulitis’

Significantly worse outcomes

Workers’ compensation patients

Compared to non-operative treatment

Data & Assumptions• N= 531

• Claimants in the Qld workers’ compensation scheme

• Documented diagnosis of ‘adhesive capsulitis’

• Finalised claims 1 January 2005 & 31 December 2010

• Only included claims where– time lost from work – medical expenses paid

• Overnight hospitalisation payment = surgery

What the figures say!Surgery led to MORE:Statutory workers comp’ payments

Time offAllied health costs

P.I. quantumCommon law quantum

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000

Surgery No surgery

Statutory payments

$-

$5,000

$10,000

$15,000

$20,000

$25,000

Surgery No surgery

Weekly Compensation Payments

0

20

40

60

80

100

120

140

160

180

200

Surgery No surgery

Time off Work (days)

$-

$50,000

$100,000

$150,000

$200,000

Surgery No surgery

Damages Payments

$15,000

$16,000

$17,000

$18,000

$19,000

$20,000

$21,000

Surgery No surgery

Permanent impairment payments

$-

$500

$1,000

$1,500

$2,000

Surgery No surgery

Phsiotherapy expenses

Does this mean that surgery for workers’ compensation patients

should never occur?

Defined indications for surgery

Stringent surgical approval process

Non-operative options fully explored

Informed consent must be comprehensive

ConclusionFigures correlational only BUT strongly suggest that

Surgical interventionfor compensated patients ‘adhesive capsulitis’ should always be carefully considered by

surgeons, insurers and patients.

QUESTIONS?