Disparities in the outcomes of lumbar spinal stenosis surgery based on insurance status
| Autor: | Kevin T. Huang, Ranjith Babu, Shivanand P. Lad, Timothy R. Owens, Matthew A. Hazzard, Chirag G. Patil, Jacob H. Bagley, Maxwell Boakye, Beatrice Ugiliweneza |
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| Rok vydání: | 2013 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Time Factors Spinal stenosis Insurance Coverage Postoperative Complications Spinal Stenosis Health care Outcome Assessment Health Care Medicine Humans Orthopedics and Sports Medicine Healthcare Disparities Aged Retrospective Studies Insurance Health Lumbar Vertebrae business.industry Medicaid Public health Laminectomy Lumbar spinal stenosis Retrospective cohort study Odds ratio Middle Aged medicine.disease Low back pain United States Surgery Spinal Fusion Multivariate Analysis Linear Models Female Neurology (clinical) medicine.symptom business Follow-Up Studies |
| Zdroj: | Spine. 38(13) |
| ISSN: | 1528-1159 |
| Popis: | 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 |
| Databáze: | OpenAIRE |
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