Elsayed Galal, McClugage Samuel G, Erwood Matthew S, Davis Matthew C, Dupépé Esther B, Szerlip Paul, Walters Beverly C, Hadley Mark N
Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and.
Department of Computer Science, University of Central Florida, Orlando, Florida.
J Neurosurg Spine. 2018 Nov 2;30(2):198-210. doi: 10.3171/2018.7.SPINE18294. Print 2019 Feb 1.
Insurance disparities can have relevant effects on outcomes after elective lumbar spinal surgery. The aim of this study was to evaluate the association between private/public payer status and patient-reported outcomes in adult patients who underwent decompression surgery for lumbar spinal stenosis. METHODS: A sample of 100 patients who underwent surgery for lumbar spinal stenosis from 2012 to 2014 was evaluated as part of the prospectively collected Quality Outcomes Database at a single institution. Outcome measures were evaluated at 3 months and 12 months, analyzed in regard to payer status (private insurance vs Medicare/Veterans Affairs insurance), and adjusted for potential confounders. RESULTS: At baseline, patients had similar visual analog scale back and leg pain, Oswestry Disability Index, and EQ-5D scores. At 3 months postintervention, patients with government-funded insurance reported significantly worse quality of life (mean difference 0.11, p < 0.001) and more leg pain (mean difference 1.26, p = 0.05). At 12 months, patients with government-funded insurance reported significantly worse quality of life (mean difference 0.14, p < 0.001). There were no significant differences at 3 months or 12 months between groups for back pain (p = 0.14 and 0.43) or disability (p = 0.19 and 0.15). Across time points, patients in both groups showed improvement at 3 months and 12 months in all 4 functional outcomes compared with baseline (p < 0.001). CONCLUSIONS: Both private and public insurance patients had significant improvement after elective lumbar spinal surgery. Patients with public insurance had slightly less improvement in quality of life after surgery than those with private insurance but still benefited greatly from surgical intervention, particularly with respect to functional status.
保险差异可能对择期腰椎手术后的结局产生相关影响。本研究的目的是评估接受腰椎管狭窄减压手术的成年患者中，私人/公共支付方身份与患者报告结局之间的关联。方法：作为前瞻性收集的单机构质量结局数据库的一部分，对2012年至2014年接受腰椎管狭窄手术的100例患者样本进行评估。在3个月和12个月时评估结局指标，根据支付方身份（私人保险与医疗保险/退伍军人事务保险）进行分析，并对潜在混杂因素进行校正。结果：在基线时，患者的视觉模拟量表背痛和腿痛、奥斯维斯特残疾指数和EQ-5D评分相似。干预后3个月，政府资助保险的患者报告生活质量显著较差（平均差异0.11，p<0.001）且腿痛更严重（平均差异1.26，p = 0.05）。在12个月时，政府资助保险的患者报告生活质量显著较差（平均差异0.14，p<0.001）。两组在3个月或12个月时的背痛（p = 0.14和0.43）或残疾（p = 0.19和0.15）无显著差异。在各个时间点，与基线相比，两组患者在所有4项功能结局的3个月和12个月时均有改善（p<0.001）。结论：择期腰椎手术后，私人保险和公共保险患者均有显著改善。公共保险患者术后生活质量的改善略低于私人保险患者，但仍从手术干预中获益巨大，尤其是在功能状态方面。
