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

Background: Postoperative 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 is to evaluate the relationship among the surgical and therapy out-of-pocket (OOP) expenses and therapy visits after operative treatment of a distal radius fracture.

Methods: We performed a retrospective cohort study of surgically treated patients with a distal radius fracture using the Merative MarketScan Research Databases (2019-2021). 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 our cohort of 17,405 patients, 1,158 (6.7%) had inpatient surgery and 16,247 (93.4%) had outpatient surgery. Additionally, 27% had no therapy visits in the six-month postoperative period. Surgical OOP costs were not associated with a minimum of one therapy visit postoperatively. However, the highest quartile of surgical OOP expenses was associated with fewer therapy visits (IRR: 0.92, 95%CI: 0.88-0.96), and the highest average therapy OOP expenses were associated with fewer therapy visits in the inpatient (IRR: 0.79, 95%CI: 0.65-0.96) and outpatient cohort (IRR: 0.86, 95%CI: 0.82-0.89).

Conclusion: One in four patients undergoing open reduction 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 therapy post-injury.