Medicaid Payer Status Is a Predictor of Early Postoperative Pain Following Upper Extremity Procedures

Abstract

Background: 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. We hypothesized that patients with Medicaid payer status would report higher levels of pre- and postoperative pain and report less postoperative pain relief. Methods: In all, 376 patients who underwent upper extremity procedures by a single surgeon at an academic ambulatory surgery center were identified. Patient information, including insurance status and Visual Analog Scale pain score (VAS-pain) at baseline, 2 weeks, and 1, 3, and 6 months, were collected. VAS-pain scores were compared with t-tests and linear regression. Results: Preoperatively 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 preoperatively, 0.39 at 1 month, and 0.79 at 3 months. Preoperatively 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 preoperatively and 0.94 at 3 months. There was no difference in pain improvement between any insurance types at any time point (all P values > .05). Conclusions: Patients with Medicaid report higher levels of preoperative pain and early postoperative 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.

Integrating mechanistic-based and classification-based concepts into perioperative pain management: an educational guide for acute pain physicians

“…Receiving disability benefits or being scheduled for a consultative medical examination for retirement were identified as a risk for PPSP at >6 months in a cohort of 453 patients who underwent sternotomies for cardiac surgery (HR 2.05 (1.40–3.02)) 69. Non-private insurance status was found to be associated with PPSP after Caesarean pain,70–72 upper extremity surgery71 and total knee arthroplasty 72. However, other studies have failed to find insurance status, a surrogate for economic status, to be a factor 73…”

Letter to the Editor: Medicaid Payer Status Is a Predictor of Early Postoperative Pain Following Upper Extremity Procedures

“…The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this 1135909H ANXXX10.1177/15589447221135909HANDRahman letter2022 1 Hospital for Special Surgery, New York, NY, USA 2 The Johns Hopkins Hospital, Baltimore, MD, USA…”

“…Corresponding Author:Duretti Fufa, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. Email: fufad@hss.eduLetter to the Editor: Medicaid Payer Status Is a Predictor of Early Postoperative Pain Following Upper Extremity ProceduresRafa Rahman 1 , Troy B. Amen 1 , Dawn Laporte 2 , and Duretti Fufa1 …”

“…We were intrigued by this recent work by Scott et al 1 on the association between Medicaid insurance status and perioperative pain. While there is value in investigating socioeconomic disparities pertinent to upper extremity surgery, we have several concerns with the methodology and conclusions.…”

Patients With Medicaid Insurance Undergoing Anterior Cruciate Ligament Reconstruction have Lower Postoperative International Knee Documentation Committee Scores and are Less Likely to Return to Sport Than Privately Insured Patients

“… 16 , 17 Medicaid insurance status also was observed to negatively impact pain scores in patients undergoing upper-extremity orthopaedic surgeries, as well as result in more resource consumption and greater complication rates in those undergoing surgery to treat proximal humerus fractures. 15 , 18 However, studies investigating this relationship in patients undergoing ACL reconstruction are limited. As Medicaid coverage has expanded over multiple states in the last decade, these disparities in surgical and functional outcomes are especially significant.…”