You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT JAMA
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 293 No. 13, April 6, 2005 TABLE OF CONTENTS
  JAMA
  •  Online Features
  Review
 This Article
 •Full text
 •PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Citing articles on Web of Science (37)
 •Contact me when this article is cited
 Related Content
 •Related article
 •Similar articles in JAMA
 Topic Collections
 •Occupational and Environmental Medicine
 •Review
 •Alert me on articles by topic
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati Add to Twitter What's this?

Association Between Compensation Status and Outcome After Surgery

A Meta-analysis

Ian Harris, FRACS(Orth); Jonathan Mulford, MB,BS; Michael Solomon, FRACS; James M. van Gelder, FRACS; Jane Young, PhD

JAMA. 2005;293:1644-1652.

Context  Compensation, whether through workers’ compensation or through litigation, has been associated with poor outcome after surgery; however, this association has not been examined by meta-analysis.

Objective  To investigate the association between compensation status and outcome after surgery.

Data Sources  We searched MEDLINE (1966-2003), EMBASE (1980-2003), CINAHL, the Cochrane Controlled Trials Register, and reference lists of retrieved articles and textbooks, and we contacted experts in the field.

Study Selection  The review included any trial of surgical intervention in which compensation status was reported and results were compared according to that status. No restrictions were placed on study design, language, or publication date. Studies were selected by 2 unblinded independent reviewers.

Data Extraction  Two reviewers independently extracted data on study type, study quality, surgical procedure, outcome, country of origin, length and completeness of follow-up, and compensation type.

Data Synthesis  Two hundred eleven studies satisfied the inclusion criteria. Of these, 175 stated that the presence of compensation (workers’ compensation with or without litigation) was associated with a worse outcome, 35 found no difference or did not describe a difference, and 1 described a benefit associated with compensation. A meta-analysis of 129 studies with available data (n = 20 498 patients) revealed the summary odds ratio for an unsatisfactory outcome in compensated patients to be 3.79 (95% confidence interval, 3.28-4.37 by random-effects model). Grouping studies by country, procedure, length of follow-up, completeness of follow-up, study type, and type of compensation showed the association to be consistent for all subgroups.

Conclusions  Compensation status is associated with poor outcome after surgery. This effect is significant, clinically important, and consistent. Because data were obtained from observational studies and were not homogeneous, the summary effect should be interpreted with caution. Compensation status should be considered a potential confounder in all studies of surgical intervention. Determination of the mechanism for this association requires further study.


Author Affiliations: Orthopaedic Department, Liverpool Hospital, Liverpool, Australia (Drs Harris and Mulford); Surgical Outcome Research Centre, Camperdown, Australia (Drs Solomon and Young); and University of New South Wales, Kensington, Australia (Dr van Gelder).



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter     What's this?

RELATED ARTICLE

Supplemental Material
JAMA. 2005;293(13):E1-E3.
EXTRACT | FULL TEXT  


THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Recombinant Human Bone Morphogenetic Protein-2 on an Absorbable Collagen Sponge with an Osteoconductive Bulking Agent in Posterolateral Arthrodesis with Instrumentation. A Prospective Randomized Trial
Dawson et al.
JBJS 2009;91:1604-1613.
ABSTRACT | FULL TEXT  

Application for disability pension and change in use of prescribed drugs. A regional Danish cohort study
Petersen et al.
Scand J Public Health 2009;37:380-386.
ABSTRACT  

Classification Accuracy of MMPI-2 Validity Scales in the Detection of Pain-Related Malingering: A Known-Groups Study
Bianchini et al.
Assessment 2008;15:435-449.
ABSTRACT  

Health status before, during and after disability pension award: the Hordaland Health Study (HUSK)
Overland et al.
Occup. Environ. Med. 2008;65:769-773.
ABSTRACT | FULL TEXT  

Understanding pain in osteoarthritis
Gwilym et al.
J Bone Joint Surg Br 2008;90-B:280-287.
ABSTRACT | FULL TEXT  

Complications of Anterior Cruciate Ligament Reconstruction With Bone-Patellar Tendon-Bone Constructs: Care and Prevention
Busam et al.
Am J Sports Med 2008;36:379-394.
ABSTRACT | FULL TEXT  

Failure within One Year Following Subtotal Lumbar Discectomy
Wera et al.
JBJS 2008;90:10-15.
ABSTRACT | FULL TEXT  

Back Pain in the Workplace
Hadler et al.
JAMA 2007;297:1594-1596.
FULL TEXT  

Malingering in Toxic Exposure: Classification Accuracy of Reliable Digit Span and WAIS-III Digit Span Scaled Scores
Greve et al.
Assessment 2007;14:12-21.
ABSTRACT  

High Pain Ratings Predict Treatment Failure in Chronic Occupational Musculoskeletal Disorders
McGeary et al.
JBJS 2006;88:317-325.
ABSTRACT | FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 2005 American Medical Association. All Rights Reserved.