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The Effect of Compensation Status on Waiting Time for Elective Surgical Lumbar Discectomy

Quon, Jeffrey A., DC, PhD*†; Levy, Adrian R., PhD*†; Sobolev, Boris, PhD†‡; Fisher, Charles G., MHSc, MD, FRCSC§; Kopec, Jacek A., MD, PhD†¶; Bishop, Paul, DC, MD, PhD; Dvorak, Marcel F., MD, FRCSC§; Schechter, Martin T., MD, PhD, FRCPC

doi: 10.1097/BRS.0b013e3181b2f233
Clinical Case Series
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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.

The effect of compensation status on waiting times for publicly funded elective surgical lumbar discectomy has not been previously examined. At a major public tertiary care center in Canada, waiting time to elective surgical lumbar discectomy was not associated with compensation status.

From the *Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada; †School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; ‡Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; §Division of Spine, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada; ¶Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada; and ∥Department of Orthopaedics, Vancouver Spine Program, Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada.

Acknowledgment date: September 14, 2008. First revision date: February 6, 2009. Second revision date: March 17, 2009. Acceptance date: March 17, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Institutional funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Supported by a Doctoral Fellowship from the Michael Smith Foundation for Health Research, and by a Postdoctoral Fellowship from the Canadian Institutes of Health Research, the Canadian Chiropractic Research Foundation and the British Columbia College of Chiropractors (to J.Q.). BC Michael Smith Foundation for Health Research Senior Scholar Award and a Canadian Institutes for Health Research New Investigator Award (to A.L) and also by Canada Research Chair Program (to B.S.) and also by an ICORD Research Professorship in Nonoperative Spine Care from the Canadian Chiropractic Research Foundation (to P.B.).

Marcel Dvorak is the Cordula and Gunther Paetzold Chair in Spinal Cord Translational Research. Martin Schechter is a Tier I Canada Research Chair.

Address correspondence to Adrian Levy, PhD, Department of Community Health and Epidemiology, Dalhousie University, Room 420, 5790 University Ave., Halifax, NS B3H 1V7.

© 2009 Lippincott Williams & Wilkins, Inc.