Insurance Status May Affect Pain Levels Post-Surgery

Patients insured through Medicaid experienced high levels of pain in the post anesthesia care unit.

Patients with public health insurance were more likely to experience high levels of pain in the post-anesthesia care unit after surgery, a recent study found.

Insurance status has been seen to affect a multitude of health care aspects, including cancer survival. A pair of studies has shown that patients who are uninsured, or are insured through Medicare, were diagnosed later, received less optimal treatment, and had shorter survival compared with patients who had other insurance.

Public health insurance was seen to affect pain levels more than other factors, such as health, age, gender, race, or neighborhood income, according to the study presented at the ANESTHESIOLOGY 2016 Annual Meeting.

“Equity is an overarching aim of the Institute of Medicine's model for quality,” said researcher Nissa Askins, MPH. “Our goal was to see if any patient characteristic or factor affected our patients' experience during a short-term, single instance of anesthesia care.”

Investigators examined whether patient characteristics affected pain following short-term surgical procedures, such as removing a child’s tonsils or removing a mass of enlarged lymphatic tissue. The study included 209 patients between the ages of 6 months and 30-years-old who received care in the post-anesthesia care unit after undergoing a surgical procedure.

Factors such as outcomes for pain, delirium, nausea, vomiting, and length of stay were examined. For children, follow-up surveys were conducted among parents to determine if there were changes in the children’s behavior, satisfaction with hospital care, and satisfaction in the post-anesthesia care unit.

Investigators found that Hispanic and African American patients were 5% and 6%, respectively, more likely to have public insurance compared with Caucasian parents. The patients with public health insurance, such through Medicaid, were seen to experience higher levels of pain, the investigators reported.

“When we further examined our sample we found that insurance type was the most important factor, independent of race, ASA status [measurement of health], age, and differences in care like perioperative opioid dose,” Askins concluded.

These findings suggest that more individualized care may be necessary to prevent high levels in pain among these patients, and that cultural influences may change how pain is expressed in children.

Additional studies are needed to further understand the relationship between personal characteristics and outcomes to better align interventions with patient needs.