How does insurance status impact scoliosis surgery outcomes and cost?

A group of researchers examined the Healthcare Cost and Utilization Project Kids’ Inpatient Database for 2000, 2003, 2006 and 2009 for patients under 18 years old who underwent surgery for idiopathic scoliosis. They included patients who had no underlying neurological disorders and underwent fusion procedures. Their results were published in Spine.


There were 19,439 surgical procedures estimated in the United States from 2000 to 2009 with 4,766 of those patients having Medicaid. The remaining 14,673 patients had private insurance. Here are 10 key notes from the study:


1. The number of spinal fusions for pediatric idiopathic scoliosis increased steadily from 2000 to 2009. In those nine years, spinal fusions for pediatric idiopathic scoliosis increased 18 percent.


2. The patients with private insurance were more likely to undergo surgery than Medicaid patient. There were 7.7 per 100,000 capita patients with private insurance, compared with 5.9 per 100,000 capita of Medicaid patients.


3. The patients with private insurance were slightly older on average than Medicaid patients — 13.9 years old versus 13.4 years old — at the time of surgery.


4. The Medicaid patient population who underwent spinal fusion for pediatric idiopathic scoliosis also tended to have a higher prevalence of other issues:


• Asthma: 10.8 percent vs. 7.4 percent
• Hypertension: 1.3 percent vs. 0.4 percent
• Hyperlipidemia: 0.3 percent vs. 0.1 percent
• Diabetes: 0.8 percent vs. 0.3 percent
• Obesity: 2.6 percent vs. 1.5 percent


5. The patients with Medicaid insurance were more likely to undergo more fusions involving nine or more vertebrae. There were 43 percent of the Medicaid patients who had nine or more levels fused, compared with 33.9 percent of private payer patients.


6. There were similar rates for in-hospital complications:


• Neurological: 1.8 percent for Medicaid vs. 1.7 percent for private
• Infections: 0.3 percent for Medicaid vs. 0.2 percent for private


7. The length of stay was longer for patients with Medicaid than private pay patients. The Medicaid patients stayed an average of 6.1 days in the hospital, versus 5.6 days for the private insurance patients.


8. The hospital costs were also higher for the Medicaid patients — $45,443 — compared with $41,635 for the private insurance patients.


9. There were several factors associated with lower rates of in-hospital neurologic complications, including:


• South and Midwest regions
• Older age
• Female sex


10. The factors associated with higher rate of in-hospital neurologic complications include:


• Cardiac disease
• Obesity
• Refusion


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