Factors Associated with Reduced Longer-Term Capacity to Work in Patients after Polytrauma: A Swiss Trauma Center Experience

BACKGROUND: Knowledge of the factors associated with longer-term reduced capacity to work (RCW) is lacking in patients after polytrauma. STUDY DESIGN: We studied a prospectively collected cohort of polytrauma survivors (n = 115; age 39.5 +/- 20.6 years [mean +/- SD]; 98% blunt trauma; Injury Severity Score [ISS] 27.5 +/- 8.2) at a university trauma center. Uni- and multivariable analyses of patient, trauma, and treatment characteristics as well as parameters of self-reported functional outcomes were studied to determine their association with a reduced capacity to work (RCW) at least 2 years after injury. RESULTS: Postinjury quality of life was worse compared with preinjury status in univariate analysis (eg, Euro Quality of Life Group Visual Analogue Scale [EQ VAS] 66.2 +/- 24.4 vs 89.7 +/- 14.7; p = <0.001). In 53% of patients (n = 61), an RCW was found and functional outcomes were significantly lower than those in non-RCW patients (p < 0.001). Lower educational status (odds ratio [OR] 0.25; 95% Cl 0.07 to 0.92; p = 0.036), higher ISS (OR 1.12; 95% Cl 1.02 to 1.22; p = 0.017), less time in the emergency room (OR 0.92; 95% CI 0.86 to 0.97; p = 0.005), higher mean nurse labor per day and patient (OR 1.01; 95% Cl 1.000 to 1.004; p = 0.033), and a reduced Nottingham Health Profile value (OR 1.10; 95% Cl 1.06 to 1.15; p < 0.001) were associated with an RCW in the multiple logistic regression model (proportion of variance explained: 0.74). CONCLUSIONS: In this cohort of patients surviving polytrauma, approximately 50% of patients sustained longer-term RCW. Several characteristics, such as level of education or trauma severity, showed an independent association with patients' capacity to work, which was significantly associated with patients' self-rated scorings of well-being. (J Am Coll Surg 2010;211:81-91. (C) 2010 by the American College of Surgeons)