Dosselman Luke J, Pernik Mark N, El Tecle Najib, Johnson Zachary, Barrie Umaru, El Ahmadieh Tarek Y, Lopez Brandon, Hall Kristen, Aoun Salah G, Bagley Carlos A
Department of Neurological Surgery, UT Southwestern, Dallas, Texas, USA.
Department of Neurological Surgery, St. Louis University Hospital, St. Louis, Missouri, USA.
World Neurosurg. 2021 Dec;156:e351-e358. doi: 10.1016/j.wneu.2021.09.065. Epub 2021 Sep 21.
Differences in insurer and payer status have been shown to increase patient hospital length of stay (LOS) by delaying the approval of transfer to a rehabilitation facility. The aim of the current study is to determine the impact of the type of insurance provider on postoperative hospital LOS after spine surgery.
In our single-institution retrospective study, all patients undergoing elective spine surgery between August 2018 and August 2019 as part of an enhanced recovery after surgery (ERAS) protocol were enrolled in a prospectively collected registry. Insurance payer type was analyzed to determine its effect on total patient LOS after surgery.
A total of 106 patients were included in the study. Insurance payers studied were Medicare, private insurers (preferred provider organization and health maintenance organization), and the Veterans Affairs payer TriWest. Patients in all groups had comparable demographic characteristics and procedural variables. There was a statistically significant difference in days stayed beyond medical clearance among the 3 insurance provider groups (P < 0.001); TriWest patients stayed an average of 3.2 days beyond clearance, compared with private insurance (1.2 days) and Medicare (0.3 days). Individual subanalysis of the ERAS complex pathway population mirrored these findings.
Hospitalization beyond medical clearance after spine surgery follows a predictable pattern regardless of ERAS pathway complexity, with Medicare having a shorter delay in approving patient progression than private insurance, which has less of a delay than Triwest.
研究表明，保险公司和支付方身份的差异会因延迟批准转至康复机构而增加患者的住院时长（LOS）。本研究的目的是确定保险提供商类型对脊柱手术后患者术后住院LOS的影响。
在我们的单机构回顾性研究中，2018年8月至2019年8月期间所有接受择期脊柱手术且作为术后加速康复（ERAS）方案一部分的患者被纳入前瞻性收集的登记系统。分析保险支付方类型以确定其对患者术后总LOS的影响。
本研究共纳入106例患者。研究的保险支付方包括医疗保险、私人保险公司（优选医疗机构和健康维护组织）以及退伍军人事务支付方TriWest。所有组别的患者在人口统计学特征和手术变量方面具有可比性。3个保险提供商组在医学检查通过后的住院天数存在统计学显著差异（P < 0.001）；TriWest组患者在检查通过后平均住院3.2天，而私人保险组为1.2天，医疗保险组为0.3天。对ERAS复杂路径人群的个体亚组分析反映了这些结果。
无论ERAS路径的复杂性如何，脊柱手术后医学检查通过后的住院情况遵循可预测的模式，医疗保险在批准患者进展方面的延迟比私人保险短，私人保险的延迟又比特里韦斯特短。
