C. T. Robertson-More1, B. Wells1,2, D. Nickerson3, A. Kirkpatrick1,2, C. Ball1,2 1University Of Calgary,General Surgery,Calgary, AB, Canada 2University Of Calgary,Trauma Surgery,Calgary, AB, Canada 3University Of Calgary,Plastic Surgery,Calgary, AB, Canada
Introduction: Work-related injuries (WRI) are common and represent a significant logistical and economic burden to health care systems. It is also possible that insurers and/or public health care systems do not account for the potentially higher cost of caring for these patients when compared to patients with non-WRI (NWRI). The primary aim of this study was to evaluate the demographics, volume, costs and outcomes associated with WRI at a high volume trauma center.
Methods: The Alberta Trauma Registry and clinical information system were used to perform a retrospective cohort study describing all patients with severe WRI (ISS>12) admitted to a high volume, tertiary care trauma referral center between April, 1995 and March, 2013. Patients who died within the emergency department were excluded. Standard statistical methodology was utilized (p<0.05).
Results: Of 14,964 total trauma admissions, 1,270 (8.5%) were for severe WRI. Overall, the patients’ mean age was 45 years with a male to female ratio of 2.8:1 and mean Injury Severity Score (ISS) of 22.7. Blunt (94%), penetrating (4%), and burn (2%) injury mechanisms were observed. Compared to patients with NWRI, the WRI group was significantly younger (41 vs. 46 years, 95% CI: -5.7 to -3.9yrs), typically male (94% vs. 72%, p<0.05), and had fewer pre-injury comorbidities (p<0.05). Although they displayed statistically equivalent ISS, the WRI group had a greater length of stay in the intensive care unit (2.8 vs. 2.3 days, 95% CI: 0.06 to 0.86 days), length of mechanical ventilation (2.2 vs. 1.8 days, 95% CI: 0.08 to 0.68 days), and mean number of surgical/operative procedures (0.86 vs. 0.67 per patient, 95% CI: 0.11 to 0.27). In contrast, significantly fewer patients with WRI died while in hospital (8% vs. 12%, p<0.05). Consequently, more patients with WRI were discharged home without support services (62% vs. 57%, p<0.05) and significantly fewer were transferred to long-term care facilities (0.5 vs. 1%, p<0.05). The acute care economic burden of patients with WRI was significantly higher (p<0.05). Increased costs were related to the care of these patients in the intensive care unit (p<0.05) and operating theatre (p<0.05), as well as for physician compensation (p<0.05).
Conclusion: Patients with WRI admitted to our trauma center were younger, less comorbid, more likely male and had a significantly higher utilization of acute care resources despite a similar ISS when compared to those with NWRI. These increased costs and economic burden in critical care, operative and physician based services are not recovered from work place insurers in public health care systems.