If only there were other ways to ensure the patient doesn't die in excruciating pain...
A hemi on this patient is bordering on malpractice. Nail or bust. Or nail and, bust anyway.
What % of patients will need opioids after the spinal wears off? If acetaminophen and ketorolac can't control the pain, you're looking at narcotics, anyway. In which case you're at the same outcome as no surgery, but you've just chunked a 5 figure procedure onto the system unnecessarily. Do you do an epidural instead and keep it running for a few days? Hell, why not just tunnel an epidural and let them die with it? That might be the best option.
Just not sure what the goal is here with surgery. You're not going the "maximum number of days" route, because they're not going to the ICU and you're not going balls to the wall on resuscitation. You're not going the "as comfortable as possible" route, because there are cheaper and faster ways to achieve that without surgery.