Return to work and productivity loss after surgery: A health economic evaluation.
Return to work and productivity loss after surgery: A health economic evaluation.
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DOI：
10.1016/j.ijsu.2021.106100
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发表时间：
2021-11
期刊：
影响因子：
--
通讯作者：
Schofield D
中科院分区：
文献类型：
--
作者：
Hah JM;Lee E;Shrestha R;Pirrotta L;Huddleston J;Goodman S;Amanatullah DF;Dirbas FM;Carroll IR;Schofield D
我们的目的是确定与重返工作（RTW）相关的术前心理社会因素，以及手术后因工作缺勤而导致的生产力损失的相关成本。研究表明，手术后生产力损失造成了很高的经济负担，但尚未研究不同手术中生产力损失相对于收入的比较成本。为随机对照试验招募的混合手术队列在手术后前瞻性随访长达两年，每天电话评估至3个月，此后每周评估至6个月，然后每月评估，以确定RTW状态，阿片类药物使用和疼痛。207例患者中的183例（88.3%）在手术前有带薪工作，至少提供了一天的随访，被纳入本分析。由于缺勤而造成的生产力损失的平均成本为13761美元（中位数为9064美元）。接受全膝关节置换术的患者收入损失最高。术前提出的医疗索赔与相对收入损失（AOR 5.09; 95%CI 1.73- 14.96; p<0.01）和术后RTW延迟显著相关。术前PTSD症状升高与RTW延迟相关（HR 0.78; 95%CI 0.63-0.96; p值=0.02），而男性（HR 1.63; 95%CI 1.11-2.38; p值=0.01）与术后RTW加快相关。由于术后生产力损失，手术给个人带来了很高的经济负担。促进手术和恢复的多学科方法，如路径，可以减轻对患者，雇主和医疗保健系统的经济后果。
We aimed to identify preoperative psychosocial factors associated with return-to-work (RTW) and the associated cost of productivity loss due to work absenteeism following surgery. Research demonstrates a high economic burden from productivity loss after surgery, but the comparative cost of productivity loss relative to income across different operations has not been examined. A mixed surgical cohort recruited for a randomized controlled trial were prospectively followed for up to two years following surgery with daily phone assessments to three months, weekly assessments thereafter to six months, then monthly assessments thereafter to determine RTW status, opioid use and pain. 183 of 207 (88.3%) patients in paid employment prior to surgery, who provided at least one day of follow-up, were included in this analysis. The average cost of productivity loss due to work absenteeism was $13 761 (median $9 064). Patients who underwent total knee replacement incurred the highest income loss. Medical claims filed before surgery were significantly associated with relative income loss (AOR 5.09;95% CI 1.73- 14.96; p<0.01) and delayed postoperative RTW. Elevated preoperative PTSD symptoms were associated with delayed RTW (HR 0.78; 95%CI 0.63-0.96; p-value=0.02) while male gender (HR 1.63; 95%CI 1.11-2.38; p-value=0.01) was associated with faster postoperative RTW. Surgery places a high economic burden on individuals due to postoperative productivity loss. Multidisciplinary approaches, such as pathways, that facilitate the operation and recovery may mitigate the economic consequences for patients, employers, and the healthcare system.
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