Evaluation of Nebraska's Outpatient Surgical Procedure Database for Occupational Health Surveillance

BACKGROUND:  Tracking outcomes of occupational injury and illness is an important tool for occupational health surveillance. While information on work-related inpatient hospitalizations and surgeries is more readily available, little is known about the extent of outpatient surgeries due to work-related injury and illness. In Nebraska, all licensed hospitals and ambulatory surgical facilities are required to report outpatient surgical procedures and related information to the Nebraska Department of Health and Human Services. Our aim is to describe work-related outpatient surgeries in Nebraska and to evaluate the potential of using these data for future occupational health surveillance activities.

METHODS:  The outpatient surgical procedures database includes all outpatient surgical procedures performed in Nebraska in each calendar year. Information related to each procedure includes the primary surgical procedure performed, billed charges, patient age, sex, and county and zip code of residence, and the primary source of payment. Outpatient surgical procedures were defined as work-related if the primary payer was listed as ‘worker’s compensation’. A descriptive analysis was conducted which identified the top 20 work-related procedures performed in 2013 and frequencies of procedures by patient demographic groups. Average billed charges for each procedure and the total charges were calculated. We also compared five-year trends of carpal tunnel surgeries with trends of carpal tunnel syndrome cases using workers’ compensation claims and the Survey of Occupational Injuries and Illnesses. 

RESULTS:  A total of 306,371 outpatient surgical procedures were performed in 2013, of which 2,013 (0.66%) were identified as work-related. A preliminary analysis found that the most frequently performed work-related procedures were knee arthroscopy/surgery (5.8%, n=117), carpal tunnel surgery (5.1%, n=102), and lumbar or sacral anesthetic agent and/or steroid injection (3.6%, n=73). Procedures with the highest average billed charges included surgical shoulder arthroscopy ($20,481), rotator cuff surgery ($15,570), and extensive debridement ($8,645).

CONCLUSIONS:  Outpatient surgical procedures data are a unique source of information relevant to occupational injury and illness outcome surveillance. These data can be useful in characterizing the overall burden and trends of outpatient surgeries attributable to work-related injuries and illnesses.