Orthopedic Fracture Surgery Linked to Lost Income for Up to 5 Years

By Lisa Rapaport

February 11, 2021

(Reuters Health) - Adults who have surgery for orthopedic fractures may experience a significant reduction in individual and household wages for the next five years - and for one in five, it can be a catastrophic loss - a U.S. study suggests.

Researchers examined hospital data and state tax records for 9,997 fracture patients treated surgically at a U.S. academic trauma center between 2003 and 2014, as well as a control group based on resampled data for pre-fracture patients at least six years prior to their injury.

Pre-injury, the mean annual individual income of tax filers was $16,847 and mean household earnings were $38,501. During the five years after injury, the study subjects received a mean annual increase of $206 in Social Security benefits.

Over this same period, fracture patients experienced a mean annual loss in individual earnings of $9,865 and a mean annual reduction in household income of $5,259.

"While we did not have data on the patient's employment status or pre-injury occupation, we assume patients earning lower incomes are more likely to earn income through physical labor employment or in positions with less job security and protection," said lead study author Nathan O'Hara, a researcher in the department of orthopedics at the University of Maryland School of Medicine, in Baltimore.

"The expected recovery time for many surgically treated fractures exceeds the duration of job protection for many individuals," O'Hara said by email. "Maintaining employment, and therefore income is likely contingent on the workplace's ability to accommodate any residual physical impairment from the injury."

Income losses were concentrated in the top three quartiles of earnings, and minimal in those with pre-injury earnings in the bottom quartile, the researchers report in JAMA Network Open.

The pre-injury risk of catastrophic wage loss was 10.5%, and this rose to 12.7% after fractures occurred. One in five patients experienced catastrophic wage loss in the two years following surgery.

Fracture patients over age 65 experienced a greater post-injury increase in Social Security benefits (161%) than those under 65 (51%).

In addition, patients with distal fractures had a greater increase in Social Security benefits (72%) than patients with proximal fractures (43%). The smallest increases in Social Security benefits went to patients with femur fractures (17%), and hand fractures (37%).

The gains in Social Security benefits, however, offset less than 10% of annual income losses, the authors note.

One limitation of the study is that self-employment income and tips or earnings from jobs earning less than $1,800 a year are not covered by the W-2 tax forms used for the analysis. As a result, many patients may have had at least some sources of income that were not included in the analysis, the study team points out.

Even so, the results underscore the importance of consulting with patients on the potential financial fallout from injuries and any potential barriers to care that may result from lost income and employee health benefits, said Dr. I. Leah Gitajn, an assistant professor of orthopedics at the Geisel School of Medicine at Dartmouth College in Hanover, New Hampshire.

Some people who sustain serious injuries whose jobs require strenuous physical activity, like heavy laborers, or those whose jobs require standing like nurses and teachers, may need to consider alternative jobs, Dr. Gitajn, who wasn't involved in the study, said by email. They may also need to spend time and money retraining for a new job, and struggle to afford physical therapy needed for optimal outcomes after surgery.

"It is important for clinicians to consider the impact of injury on patients' lives as a whole," Dr. Gitajn said. "People who sustain fractures that require surgery would benefit from a more comprehensive case management approach beyond effective fracture treatment, including cost effective and accessible physical therapy and job retraining resources, effective pain management for those with persistent and chronic pain and access to additional resources for those experiencing housing or food insecurity."

SOURCE: https://bit.ly/3aWPUKC JAMA Network Open, online February 8, 2021.