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Disparities in the outcomes of lumbar spinal stenosis surgery based on insurance status.

Publication ,  Journal Article
Lad, SP; Huang, KT; Bagley, JH; Hazzard, MA; Babu, R; Owens, TR; Ugiliweneza, B; Patil, CG; Boakye, M
Published in: Spine (Phila Pa 1976)
June 1, 2013

STUDY DESIGN: Retrospective cohort study using Thomson Reuter's MarketScan database. OBJECTIVE: To evaluate the extent to which Medicaid versus commercial insurance status affects outcomes after lumbar stenosis surgery. SUMMARY OF BACKGROUND DATA: The Affordable Care Act aims to expand health insurance and to help narrow existing health care disparities. Medicaid patients have previously been noted to be at an increased risk for impaired access to health care. Conversely, those with commercial insurance may be subject to overtreatment. We examine the surgical treatment of low back pain as an example that has raised significant public health concerns. METHODS: A total of 28,462 patients, ages 18 and older, were identified who had undergone laminectomy or fusion for spinal stenosis between 2000 and 2009. Patients were characterized by baseline demographic information, comorbidity burden, and type of insurance (Medicaid vs. commercial insurance). Multivariate analysis was performed comparing the relative effect of insurance status on reoperation rates, timing and type of reoperations, postoperative complications, and total postoperative health resource use. RESULTS: Medicaid patients had similar reoperation rates to commercially insured patients at 1 year (4.60% vs. 5.42%, P = .38); but had significantly lower reoperation rates at 2 (7.22% vs. 10.30%; adjusted odds ratio [aOR] = 0.661; 95% confidence interval [CI], 0.533-0.820; P = .0002) and more than 2 years (13.92% vs. 16.89%; aOR = 0.722; 95% CI, 0.612-0.851; P <.0001). Medicaid patients were particularly less likely to undergo fusion as a reoperation (aOR = 0.478; 95% CI, 0.377-0.606; P < 0001). Medicaid patients had greater health care resource utilization as measured by hospital days, outpatient services and medications prescribed; however, commercially insured patients had significantly higher overall health utilization costs at 1 and 2 years. CONCLUSION: There are insurance disparities that affect important surgical outcomes after initial surgery for spinal stenosis. Efforts for national health care reform should include explicit efforts to identify such system factors that will reduce current inequities in care. LEVEL OF EVIDENCE: 2.

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Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

June 1, 2013

Volume

38

Issue

13

Start / End Page

1119 / 1127

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Spinal Stenosis
  • Spinal Fusion
  • Retrospective Studies
  • Reoperation
  • Postoperative Complications
  • Outcome Assessment, Health Care
  • Orthopedics
  • Multivariate Analysis
 

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Lad, S. P., Huang, K. T., Bagley, J. H., Hazzard, M. A., Babu, R., Owens, T. R., … Boakye, M. (2013). Disparities in the outcomes of lumbar spinal stenosis surgery based on insurance status. Spine (Phila Pa 1976), 38(13), 1119–1127. https://doi.org/10.1097/BRS.0b013e318287f04e
Lad, Shivanand P., Kevin T. Huang, Jacob H. Bagley, Matthew A. Hazzard, Ranjith Babu, Timothy Ryan Owens, Beatrice Ugiliweneza, Chirag G. Patil, and Maxwell Boakye. “Disparities in the outcomes of lumbar spinal stenosis surgery based on insurance status.Spine (Phila Pa 1976) 38, no. 13 (June 1, 2013): 1119–27. https://doi.org/10.1097/BRS.0b013e318287f04e.
Lad SP, Huang KT, Bagley JH, Hazzard MA, Babu R, Owens TR, et al. Disparities in the outcomes of lumbar spinal stenosis surgery based on insurance status. Spine (Phila Pa 1976). 2013 Jun 1;38(13):1119–27.
Lad, Shivanand P., et al. “Disparities in the outcomes of lumbar spinal stenosis surgery based on insurance status.Spine (Phila Pa 1976), vol. 38, no. 13, June 2013, pp. 1119–27. Pubmed, doi:10.1097/BRS.0b013e318287f04e.
Lad SP, Huang KT, Bagley JH, Hazzard MA, Babu R, Owens TR, Ugiliweneza B, Patil CG, Boakye M. Disparities in the outcomes of lumbar spinal stenosis surgery based on insurance status. Spine (Phila Pa 1976). 2013 Jun 1;38(13):1119–1127.

Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

June 1, 2013

Volume

38

Issue

13

Start / End Page

1119 / 1127

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Spinal Stenosis
  • Spinal Fusion
  • Retrospective Studies
  • Reoperation
  • Postoperative Complications
  • Outcome Assessment, Health Care
  • Orthopedics
  • Multivariate Analysis