Out-of-Pocket Expenses and Postoperative Therapy after Open Reduction and Internal Fixation of a Distal Radius Fracture

Abstract

Background: Hand therapy after surgery for distal radius fractures is associated with improved functional outcomes. However, financial impediments can be a potential barrier to adherence to postoperative care requirements. The aim of this study was to evaluate the relationship between surgical and therapy out-of-pocket (OOP) expenses and therapy visits after operative treatment of a distal radius fracture.

Methods: The authors performed a retrospective cohort study of surgically treated patients with a distal radius fracture using Merative MarketScan Research Databases (2019 through 2021). Multivariable logistic regression and multivariable negative binomial regression were used to assess the association of patient-level variables, OOP expenses, and postoperative hand therapy visits.

Results: In the cohort of 17,405 patients, 1158 (6.7%) had inpatient surgery and 16,247 (93.4%) had outpatient surgery. A total of 27% had no therapy visits in the 6-month postoperative period. Surgical OOP costs were not associated with a minimum of 1 therapy visit postoperatively. However, the highest quartile of surgical OOP expenses was associated with fewer therapy visits (incidence rate ratio [IRR], 0.92 [95% CI, 0.88 to 0.96]), and the highest average therapy OOP expenses were associated with fewer therapy visits in the inpatient (IRR, 0.79 [95% CI, 0.65 to 0.96]) and outpatient (IRR, 0.86 [95% CI, 0.82 to 0.89]) cohorts.

Conclusions: One in 4 patients undergoing open reduction and internal fixation of a distal radius fracture did not receive therapy. Increasing surgical and therapy OOP expenses were associated with fewer therapy visits. Given the importance of therapy for functional outcomes, policy changes, such as bundling therapy visits into the global period, are needed to promote postinjury therapy.