Medicaid Payer Status is a Predictor of Early Post-operative Pain Following Upper Extremity Procedures
Allison A. Boden, MD1, Lauren Boden, MD2, Stephanie Boden, MD3, Kevin Xavier Farley, BS4 and Michael Brandon Gottschalk, MD4, (1)University of Miami, Miami, FL, (2)University of Pennsylvania, Philadelphia, PA, (3)University of Pittsburgh, Pittsburgh, PA, (4)Emory University, Atlanta, GA
Introduction: As the number of patients receiving insurance through Medicaid increases, it is important to understand how patient insurance status relates to outcomes following surgery. The purpose of this study was to investigate the relationship between insurance status and patient reported pain both before and after upper extremity surgical procedures, specifically patients with Medicaid payer status. We hypothesized that patients with Medicaid payer status would report higher levels of pre- and post-operative pain and report less post-operative pain relief.
Methods: 376 patients who underwent upper extremity procedures between September 1, 2015 to July 1, 2017 by a single surgeon at an academic ambulatory surgery center were identified. Retrospective review of prospectively collected data was performed in order to obtain patient information, including insurance status and visual analog pain scales (VAS-pain) at baseline, 2-weeks, and 1, 3, and 6-months. VAS-pain scores were compared with t-tests and a multivariate linear regression modeling to control for potential confounding.
Results: Pre-operatively and at 2-week, 1-month, and 3-month follow-up, Medicaid patients reported statistically significant higher pain levels than patients with Private insurance, finding a mean adjusted increase of 0.51 pre-operatively (95% Confidence Interval [CI]: 0.26, 0.77), 0.38 at 2 weeks (95% CI: 0.15, 0.62), 0.39 at 1-month (95% CI: 0.11, 0.66), and 0.79 at 3-months (95% CI: 0.49, 1.09). Pre-operatively and at 3-month follow-up, Medicaid patients reported statistically significant higher pain than patients with Medicare, finding increases in VAS-pain of 0.99 pre-operatively (95% CI: 0.47, 1.50) and 0.94 at 3 months (95% CI: 0.15-1.73). On multivariate analysis, there were no differences in pain scores in Medicaid versus uninsured patients (all p values > 0.05) or Medicare and privately insured patients (all p values > 0.05). There was no difference in pain improvement between any insurance types at any time point (all p values > 0.05).
Discussion and Conclusion: Patients with Medicaid report higher levels of pre-operative pain and early post-operative pain, but reported the same improvement in pain as patients with other types of insurance. As healthcare systems are becoming increasingly dependent on patient-reported outcomes, including pain, it is important to consider that differences may exist in subjective pain depending on insurance status. In addition, a greater understanding of the factors influencing preoperative pain levels and postoperative pain relief can help to improve patient education of what to expect before and after surgery leading to improved patient care and satisfaction.
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