The effect of time to amputation on medical costs accrued during the first twelve months after injury—A California workers’ compensation claims study

Abstract

Background: This study investigated whether the time to amputation (TtoA) after a work-related injury had a significant effect on the medical costs accrued in the first year after injury. Data source: Six thousand nine hundred fifty-three person-level workers’ compensation claims data from the state of California, USA, from 2007 to 2018. Methods: Multiple quantile regression was used to assess the impact of TtoA on medical costs accrued during the first 12 months after injury. Three time intervals for TtoA were investigated: immediate (0, 1 days), short-delay (2–31 days), and long-delay (>31 days). Results: The median (interquartile range) medical dollars paid per claim during the first 12 months for the study population was $12,414 ($6,324–$29,347). Amputations that occurred during the short-delay time interval resulted in significant (p < 0.001) median (95% CI) savings of −$3,196 (−$3,968 to −$2,424) compared with the immediate amputation group. The long-delay time interval resulted in significantly (p < 0.001) increased median (95% CI) spending of $5,613 ($4,675–$6,551) compared with the immediate amputation group. Covariates that significantly increased costs were medical intensity, medical complexity, use of a prosthesis, and if the injured worker pursued legal action in addition to a workers’ compensation claim. Conclusions: This study presents the impact of TtoA on medical spending in the first year after a work-related injury that results in an amputation. Amputations that occurred within the first month after an injury resulted in reduced medical spending compared with immediate amputations, and amputations that occurred after the first month resulted in increased medical spending.