title: Patient factors influencing return to work and cumulative financial claims after clavicle fractures in workers' compensation cases.
abstract: BACKGROUND
  This study analyzed workers' compensation patients after surgical or nonoperative treatment of clavicle fractures to identify factors that influence the time for return to work and total health care reimbursement claims. We hypothesized that return to work for operative patients would be faster.
  
  
  METHODS
  The International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes and Current Procedural Terminology codes were used to retrospectively query the Workers' Compensation national database. The outcomes of interest were the number of days for return to full work after surgery and total reimbursement for health care-related claims. The primary independent variable was treatment modality.
  
  
  RESULTS
  There were 169 claims for clavicle fractures within the database (surgical, n = 34; nonoperative, n = 135). The average health care claims reimbursed were $29,136 ± $26,998 for surgical management compared with $8366 ± $14,758 for nonoperative management (P < .001). We did not find a statistically significant difference between surgical (196 ± 287 days) and nonoperative (69 ± 94 days) treatment groups in their time to return to work (P = .06); however, there was high variability in both groups. Litigation was an independent predictor of prolonged return to work (P = .007) and higher health care costs (P = .003).
  
  
  CONCLUSIONS
  Workers' compensation patients treated for clavicle fractures return to work at roughly the same time whether they are treated surgically or nonoperatively, with surgery being roughly 3 times more expensive. There was a substantial amount of variability in return to work timing by subjects in both groups. Litigation was a predictor of longer return to work timing and higher health care costs.
authors.affiliation: Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Shields
authors.affiliation: Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Thirukumaran
authors.affiliation: Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Thorsness
authors.affiliation: Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Katia
authors.initials: K
authors.lastname: Noyes
authors.affiliation: Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: Ilya_Voloshin@urmc.rochester.edu.
authors.forename: Ilya
authors.initials: I
authors.lastname: Voloshin
mesh_terms: D000328:Adult; D002968:Clavicle / Q000293:injuries*; D016208:Databases, Factual; D005260:Female; D050723:Fractures, Bone / Q000191:economics* / Q000601:surgery / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D062707:Return to Work; D013997:Time Factors; D014942:Workers' Compensation / Q000191:economics* / Q000331:legislation & jurisprudence
keywords: Return to work; clavicle fracture; cost effectiveness; health care costs; health care reimbursement; workers' compensation