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Predictors of Return to Work After Carpal Tunnel Release in a Workers' Compensation Population
Jenniefer Y. Kho, MD; Michael Gaspar, MD; Patrick Kane, MD; Sidney M. Jacoby, MD; Eon K. Shin, MD
Thomas Jefferson University, Philadelphia Hand Center, Philadelphia, PA

Purpose: Workers' compensation (WC) patients take longer to return to work after surgery than non-compensated patients for a variety of reasons. We hypothesized that psychosocial factors could be a predominant factor of time to return to work (RTW) in the WC population.

Methods: This retrospective review examined all WC patients who underwent open carpal tunnel release surgery over a five-year period by one of three fellowship-trained hand surgeons at a single institution. One-hundred and sixty wrists in 115 patients (70 unilateral, 45 bilateral) satisfied inclusion criteria. Demographic, medical and surgical data were obtained from patient records. Univariate and multivariate analyses were performed to assess predictors of RTW.

Results: Average age at the time of surgery was 49.5 +/- 8.7 years. Females comprised 61% of the patients. Eighty-nine percent of all patients returned back to full duty. Average return to work in all wrists was 12.53 weeks (SD +/- 11.29), compared to 3 weeks in historical controls. There was no significant difference in RTW between unilateral and bilateral surgery (p=0.60). Predictors of delayed RTW in multivariate analyses were depression with or without anxiety (p<0.001), chronic pain and/or fibromyalgia (p=0.003), history of opioid use (p=0.001), and pre-operative work status (full-duty versus not full-duty) (p<0.001). In a multivariate regression model, these factors accounted for 68% of the variance in RTW in the WC population. Neither pre-operative motor nerve conduction velocity nor job type was predictive of RTW.

Conclusions: In this study, patients with a WC claim took longer to return to work after carpal tunnel release surgery than patients without such a claim. A psychiatric diagnosis of depression and anxiety was the most predictive factor of RTW, followed by opioid use, chronic pain conditions, and pre-operative work status. These factors explained nearly 70% of the variation in RTW. Disease severity and job type did not necessarily delay RTW. The aforementioned factors can help prognosticate which WC patients will have a protracted post-operative recovery and perhaps target additional therapeutic intervention to facilitate a more rapid return to work and finally, to inform employers of which patients could be expected to return to work in delayed fashion.

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