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Multicenter Study
. 2024 Jan 1;38(1):42-48.
doi: 10.1097/BOT.0000000000002681.

Work Productivity Loss After Minimally Displaced Complete Lateral Compression Pelvis Fractures

Natasha S McKibben  1 , Nathan N O'Hara  1 , Gerard P Slobogean  1 , Greg E Gaski  2 , Jason W Nascone  1 , Marcus F Sciadini  1 , Roman M Natoli  3 , Todd McKinley  3 , Walter W Virkus  3 , Anthony T Sorkin  3 , Andrea Howe  1 , Robert V O'Toole  1 , Joseph F Levy  4
Affiliations
Multicenter Study

Work Productivity Loss After Minimally Displaced Complete Lateral Compression Pelvis Fractures

Natasha S McKibben et al. J Orthop Trauma. .

Abstract

Objective: To quantify work impairment and economic losses due to lost employment, lost work time (absenteeism), and lost productivity while working (presenteeism) after a lateral compression pelvic ring fracture. Secondarily, productivity loss of patients treated with surgical fixation versus nonoperative management was compared.

Design: Secondary analysis of a prospective, multicenter trial.

Setting: Two level I academic trauma centers.

Patient selection criteria: Adult patients with a lateral compression pelvic fracture (OTA/AO 61-B1/B2) with a complete posterior pelvic ring fracture and less than 10 mm of initial displacement. Excluded were patients who were not working or non-ambulatory before their pelvis fracture or who had a concomitant spinal cord injury.

Outcome measures and comparisons: Work impairment, including hours lost to unemployment, absenteeism, and presenteeism, measured by Work Productivity and Activity Impairment assessments in the year after injury. Results after non-operative and operative treatment were compared.

Results: Of the 64 included patients, forty-seven percent (30/64) were treated with surgical fixation, and 53% (30/64) with nonoperative management. 63% returned to work within 1 year of injury. Workers lost an average of 67% of a 2080-hour average work year, corresponding with $56,276 in lost economic productivity. Of the 1395 total hours lost, 87% was due to unemployment, 3% to absenteeism, and 10% to presenteeism. Surgical fixation was associated with 27% fewer lost hours (1155 vs. 1583, P = 0.005) and prevented $17,266 in average lost economic productivity per patient compared with nonoperative management.

Conclusions: Lateral compression pelvic fractures are associated with a substantial economic impact on patients and society. Surgical fixation reduces work impairment and the corresponding economic burden.

Level of evidence: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Trial registration: ClinicalTrials.gov NCT02625766.

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Conflict of interest statement

N. N. O'Hara receives stock or stock options from Arbutus Medical, Inc unrelated to this research. G. P. Slobogean receives research funding from the Patient-Centered Outcomes Research Institute, the US Department of Defense, and the National Institutes of Health, unrelated to this research; and is a paid consultant for Smith & Nephew and Zimmer, unrelated to this research. G. E. Gaski receives royalties from Thieme unrelated to this research. J. W. Nascone is a paid consultant for DePuy, receives IP royalties from CoorsTek and Synthes, and receives stock options from Imagen, all unrelated to this research. M. F. Sciadini is a paid consultant for Globus Medical and Stryker, receives IP royalties from Globus Medical, and receives stock options from Stryker, all unrelated to this research. R. M. Natoli receives financial or material support from MicroGen Dx, receives royalties from Morgan & Claypool, and receives research support from Novasteo, all unrelated to this research. T. McKinley receives IP royalties from Innomed unrelated to this research. W. W. Virkus is a paid consultant for Stryker; is a paid employee for Novartis; receives stock options from Connextions, GLW, Inc, Johnson & Johnson, and Olio, Inc; and receives royalties from Slack Inc; all unrelated to this research. A. T. Sorkin is a paid consultant for Stryker and receives stock or stock options from Johnson & Johnson, unrelated to this research. R. V. O'Toole is a paid consultant for Stryker, receives stock options from Imagen, and receives royalties from Lincotek, all unrelated to this research. The remaining authors report no conflict of interest.

Figures

Figure 1.
Figure 1.
Hours lost overall, to absenteeism, and to presenteeism, each week were modeled over the year following injury and include bootstrapped 95% confidence intervals. Total hours lost decreases over time, though absenteeism and presenteeism simultaneously increase as more patients return to work without being completely productive.
Figure 2.
Figure 2.
Hours lost over time for patients after operative and nonoperative treatments. Total hours lost decreases over time for both groups. However, the rate of hours lost declines sooner for those treated with surgical fixation, suggesting patients are returning to productive work at an earlier timepoint. As a result, more patients reported higher presenteeism while at work after operative treatment. We calculated the 95% confidence intervals using bootstrap resampling.
Figure 3.
Figure 3.
Total hours lost over the year following pelvis fractures by patient and injury characteristics. The difference observed between operative and nonoperative treatment was greater than any other subgroup effect. Hours lost also diverged between age groups, physical job demands, and education levels. No differential effects were noted between injury characteristics or patient sex.
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References

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