The 1-Year Economic Impact of Work Productivity Loss Following Severe Lower Extremity Trauma

Joseph F Levy; Lisa Reider; Daniel O Scharfstein; Andrew N Pollak; Saam Morshed; Reza Firoozabadi; Kristin R Archer; Joshua L Gary; Robert V O'Toole; Renan C Castillo; Stephen M Quinnan; Laurence B Kempton; Clifford B Jones; Michael J Bosse; Ellen J MacKenzie; METRC

doi:10.2106/JBJS.21.00632

The 1-Year Economic Impact of Work Productivity Loss Following Severe Lower Extremity Trauma

J Bone Joint Surg Am. 2022 Apr 6;104(7):586-593. doi: 10.2106/JBJS.21.00632. Epub 2022 Jan 28.

Authors

Collaborators

Affiliations

¹ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
² Department of Population Health Science, University of Utah School of Medicine, Salt Lake City, Utah.
³ Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland.
⁴ Departments of Orthopaedic Surgery, Epidemiology, and Biostatistics, University of California San Francisco, San Francisco, California.
⁵ Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, Washington.
⁶ Department of Orthopaedic Surgery, Center for Musculoskeletal Research and Department of Physical Medicine and Rehabilitation and Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
⁷ Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
⁸ The Paley Orthopedic & Spine Institute at St. Mary's Medical Center, West Palm Beach, Florida.
⁹ Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina.
¹⁰ Dignity Health Medical Group, St. Joseph's Hospital Medical Center & Creighton University School of Medicine, Phoenix, Arizona.

PMID: 35089905
DOI: 10.2106/JBJS.21.00632

Abstract

Background: Severe lower extremity trauma among working-age adults is highly consequential for returning to work; however, the economic impact attributed to injury has not been fully quantified. The purpose of this study was to examine work and productivity loss during the year following lower extremity trauma and to calculate the economic losses associated with lost employment, lost work time (absenteeism), and productivity loss while at work (presenteeism).

Methods: This is an analysis of data collected prospectively across 3 multicenter studies of lower extremity trauma outcomes in the United States. Data were used to construct a Markov model that accumulated hours lost over time due to lost employment, absenteeism, and presenteeism among patients from 18 to 64 years old who were working prior to their injury. Average U.S. wages were used to calculate economic loss overall and by sociodemographic and injury subgroups.

Results: Of 857 patients working prior to injury, 47.2% had returned to work at 1 year. The average number of productive hours of work lost was 1,758.8/person, representing 84.6% of expected annual productive hours. Of the hours lost, 1,542.3 (87.7%) were due to working no hours or lost employment, 71.1 (4.0%) were due to missed hours after having returned, and 145.4 (8.3%) were due to decreased productivity while working. The 1-year economic loss due to injury totaled $64,427/patient (95% confidence interval [CI], $63,183 to $65,680). Of the 1,758.8 lost hours, approximately 88% were due to not being employed (working zero hours), 4% were due to absenteeism, and 8% were due to presenteeism. Total productivity loss was higher among older adults (≥40 years), men, those with a physically demanding job, and the most severe injuries (i.e., those leading to amputation as well as Gustilo type-IIIB tibial fractures and type-III pilon/ankle fractures).

Conclusions: Patients with severe lower extremity trauma carry a substantial economic burden. The costs of lost productivity should be considered when evaluating outcomes.