TY - JOUR
T1 - Inferior Clinical Outcomes for Patients with Medicaid Insurance After Surgery for Degenerative Lumbar Spondylolisthesis
T2 - A Prospective Registry Analysis of 608 Patients
AU - Chan, Andrew K.
AU - Letchuman, Vijay
AU - Mummaneni, Praveen V.
AU - Burke, John F.
AU - Agarwal, Nitin
AU - Bisson, Erica F.
AU - Bydon, Mohamad
AU - Foley, Kevin T.
AU - Shaffrey, Christopher I.
AU - Glassman, Steven D.
AU - Wang, Michael Y.
AU - Park, Paul
AU - Potts, Eric A.
AU - Shaffrey, Mark E.
AU - Coric, Domagoj
AU - Knightly, John J.
AU - Fu, Kai Ming
AU - Slotkin, Jonathan R.
AU - Asher, Anthony L.
AU - Virk, Michael S.
AU - Kerezoudis, Panagiotis
AU - Alvi, Mohammed A.
AU - Guan, Jian
AU - Haid, Regis W.
AU - DiGiorgio, Anthony
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/8
Y1 - 2022/8
N2 - Background: It remains unclear how type of insurance coverage affects long-term, spine-specific patient-reported outcomes (PROs). This study sought to elucidate the impact of insurance on clinical outcomes after lumbar spondylolisthesis surgery. Methods: The prospective Quality Outcomes Database registry was queried for patients with grade 1 degenerative lumbar spondylolisthesis who underwent single-segment surgery. Twenty-four-month PROs were compared and included Oswestry Disability Index, Numeric Rating Scale (NRS) back pain, NRS leg pain, EuroQol-5D, and North American Spine Society Satisfaction. Results: A total of 608 patients undergoing surgery for grade 1 degenerative lumbar spondylolisthesis (mean age, 62.5 ± 11.5 years and 59.2% women) were selected. Insurance types included private insurance (n = 319; 52.5%), Medicare (n = 235; 38.7%), Medicaid (n = 36; 5.9%), and Veterans Affairs (VA)/government (n = 17; 2.8%). One patient (0.2%) was uninsured and was removed from the analyses. Regardless of insurance status, compared to baseline, all 4 cohorts improved significantly regarding ODI, NRS-BP, NRS-LP, and EQ-5D scores (P < 0.001). In adjusted multivariable analyses, compared with patients with private insurance, Medicaid was associated with worse 24-month postoperative Oswestry Disability Index (β = 10.2; 95% confidence interval [CI], 3.9–16.5; P = 0.002) and NRS leg pain (β =1.3; 95% CI, 0.3–2.4; P = 0.02). Medicaid was associated with worse EuroQol-5D scores compared with private insurance (β = −0.07; 95% CI −0.01 to −0.14; P = 0.03), but not compared with Medicare and VA/government insurance (P > 0.05). Medicaid was associated with lower odds of reaching ODI minimal clinically important difference (odds ratio, 0.2; 95% CI, 0.03–0.7; P = 0.02) compared with VA/government insurance. NRS back pain and North American Spine Society satisfaction did not differ by insurance coverage (P > 0.05). Conclusions: Despite adjusting for potential confounding variables, Medicaid coverage was independently associated with worse 24-month PROs after lumbar spondylolisthesis surgery compared with other payer types. Although all improved postoperatively, those with Medicaid coverage had relatively inferior improvements.
AB - Background: It remains unclear how type of insurance coverage affects long-term, spine-specific patient-reported outcomes (PROs). This study sought to elucidate the impact of insurance on clinical outcomes after lumbar spondylolisthesis surgery. Methods: The prospective Quality Outcomes Database registry was queried for patients with grade 1 degenerative lumbar spondylolisthesis who underwent single-segment surgery. Twenty-four-month PROs were compared and included Oswestry Disability Index, Numeric Rating Scale (NRS) back pain, NRS leg pain, EuroQol-5D, and North American Spine Society Satisfaction. Results: A total of 608 patients undergoing surgery for grade 1 degenerative lumbar spondylolisthesis (mean age, 62.5 ± 11.5 years and 59.2% women) were selected. Insurance types included private insurance (n = 319; 52.5%), Medicare (n = 235; 38.7%), Medicaid (n = 36; 5.9%), and Veterans Affairs (VA)/government (n = 17; 2.8%). One patient (0.2%) was uninsured and was removed from the analyses. Regardless of insurance status, compared to baseline, all 4 cohorts improved significantly regarding ODI, NRS-BP, NRS-LP, and EQ-5D scores (P < 0.001). In adjusted multivariable analyses, compared with patients with private insurance, Medicaid was associated with worse 24-month postoperative Oswestry Disability Index (β = 10.2; 95% confidence interval [CI], 3.9–16.5; P = 0.002) and NRS leg pain (β =1.3; 95% CI, 0.3–2.4; P = 0.02). Medicaid was associated with worse EuroQol-5D scores compared with private insurance (β = −0.07; 95% CI −0.01 to −0.14; P = 0.03), but not compared with Medicare and VA/government insurance (P > 0.05). Medicaid was associated with lower odds of reaching ODI minimal clinically important difference (odds ratio, 0.2; 95% CI, 0.03–0.7; P = 0.02) compared with VA/government insurance. NRS back pain and North American Spine Society satisfaction did not differ by insurance coverage (P > 0.05). Conclusions: Despite adjusting for potential confounding variables, Medicaid coverage was independently associated with worse 24-month PROs after lumbar spondylolisthesis surgery compared with other payer types. Although all improved postoperatively, those with Medicaid coverage had relatively inferior improvements.
KW - Insurance
KW - Lumbar
KW - Medicaid
KW - Medicare
KW - Patient-reported outcomes
KW - Quality outcomes database
KW - Spondylolisthesis
UR - https://www.scopus.com/pages/publications/85135599256
U2 - 10.1016/j.wneu.2022.05.094
DO - 10.1016/j.wneu.2022.05.094
M3 - Article
C2 - 35636667
AN - SCOPUS:85135599256
SN - 1878-8750
VL - 164
SP - e1024-e1033
JO - World neurosurgery
JF - World neurosurgery
ER -