The association between insurance status and complications, length of stay, and costs for pediatric idiopathic scoliosis

Abstract

Study design: Observational cross-sectional population study using national sample of pediatric hospital discharges from 2000 to 2009.

Objective: To determine whether there is an association between insurance status and in-hospital surgical outcome for pediatric patients with idiopathic scoliosis.

Summary of background data: Association between health insurance status and in-hospital surgical outcome after spinal fusion for pediatric idiopathic scoliosis is unknown.

Methods: An analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database 2000, 2003, 2006, and 2009 was performed. Patients aged 0 to younger than 18 years with idiopathic scoliosis and no underlying neurological disorders who underwent fusion were included. National trends, patient, hospital and surgical characteristics, postoperative in-hospital complications, and associated factors were studied. Univariate analysis and multivariable logistic regressions were used.

Results: An estimated 19,439 surgical procedures (Medicaid 4766 vs. private 14,673) were performed for pediatric idiopathic scoliosis from 2000 to 2009 in the United States. Spinal fusions for pediatric idiopathic scoliosis steadily increased from 2000 to 2009 by 18.0%. Patients with private insurance were more likely to undergo surgery than patients with Medicaid insurance (7.7 vs. 5.9 per 100,000 capita; P = 0.003). Patients with private insurance were slightly older than patients with Medicaid insurance at the time of surgery (mean age = 13.9 yr vs. 13.4 yr; P < 0.001). Patients with Medicaid insurance had a higher prevalence of asthma (10.8% vs. 7.4%; P < 0.001), hypertension (1.4% vs. 0.4%; P < 0.001), hyperlipidemia (0.3% vs. 0.1%; P = 0.01), diabetes (0.8% vs. 0.3%; P < 0.001), and obesity (2.6% vs. 1.5%; P < 0.001). Patients with Medicaid insurance underwent more fusions involving 9 or more vertebrae than private patients (43.0% vs. 33.9%; P < 0.001). Postoperative in-hospital complications, including neurological (Medicaid 1.8% vs. private 1.7%; P = 0.64) and infectious (Medicaid 0.3% vs. private 0.2%; P = 0.44), were similar. Length of stay was longer (6.1 d vs. 5.6 d; P < 0.001) and hospital costs were higher ($45,443 vs. $41,635; P < 0.001) for patients with Medicaid insurance. Surgery performed in the South and Midwest regions, older age, and female sex were associated with lower rates of in-hospital neurological complications, whereas the presence of cardiac disease, obesity, and refusion were associated with higher rates of in-hospital neurological complications.

Conclusion: Patients with Medicaid insurance were younger, underwent longer fusions, and had more medical comorbidities than patients with private insurance. However, insurance status was not associated with an increased rate of postoperative in-hospital complications.

Level of evidence: 4.