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The effect of compensation status on waiting time for elective surgical lumbar discectomy
Jeffrey A Quon1, Adrian R Levy, Boris Sobolev
1Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Study Design:
Prospective cohort study of patients registered for elective surgical lumbar discectomy (ESLD) between November 1999 and December 2003 at a major tertiary care center in Vancouver.
Objective:
To determine whether compensation status was associated with longer waiting time for ESLD.
Summary Of Background Data:
In Canada, access to publicly funded ESLD is managed through waitlists. Patients are prioritized according to case severity and clinical need. However, it is not known whether compensation status is associated with waiting times.
Methods:
Patients with sciatica from herniated lumbar disc, confirmed on advanced imaging, were registered for surgery. Information was collected on 393 patients, 66 (17%) who were receiving workers' compensation or personal disability insurance. Waiting time was calculated from registration to surgery and back pain and leg pain intensities were assessed by surgeons, using an 11-point numerical rating scale. Weekly probabilities of remaining on the waitlist were estimated using Kaplan-Meier methods. Patients undergoing emergency surgery or waiting longer than 12 months were censored. Waiting times were compared using the log-rank test, and Cox regression was used to estimate the effect of compensation on waiting after controlling for confounders.
Results:
Pain intensity, neurologic status, and symptom duration were associated with waiting time. Compensation status was associated with a lower, statistically nonsignificant, likelihood of undergoing ESLD; hazard ratio (HR) = 0.83 (95% CI: 0.63-1.11) and the effect was attenuated with adjustment; HR = 1.02 (95% CI: 0.76-1.38). The median adjusted waiting time for surgery was 7 weeks among noncompensated and compensated patients.
Conclusion:
These results provide evidence that, contrary to conventional wisdom, compensation status was not associated with longer waits for ESLD. While patients receiving compensation have elsewhere been observed to have worse outcomes after discectomy, our results suggest this is unlikely to be due to delays imposed by queuing.