Department of Neurological Surgery, University of California, San Francisco, California, USA.
Department of Neurological Surgery, University of California, San Francisco, California, USA.
World Neurosurg. 2022 Aug;164:e1024-e1033. doi: 10.1016/j.wneu.2022.05.094. Epub 2022 May 27.
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.
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.
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).
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.
保险类型如何影响脊柱特定的长期患者报告结果（PROs）尚不清楚。本研究旨在阐明保险对腰椎滑脱手术后临床结果的影响。
前瞻性质量结果数据库登记处检索了接受单节段手术的 1 级退行性腰椎滑脱患者。比较了 24 个月的 PROs，包括 Oswestry 残疾指数、数字评分量表（NRS）腰痛、NRS 腿痛、欧洲五维健康量表（EQ-5D）和北美脊柱协会满意度。
共选择了 608 名接受 1 级退行性腰椎滑脱手术的患者（平均年龄 62.5±11.5 岁，59.2%为女性）。保险类型包括私人保险（n=319；52.5%）、医疗保险（n=235；38.7%）、医疗补助（n=36；5.9%）和退伍军人事务部/政府（n=17；2.8%）。有 1 名（0.2%）无保险的患者被排除在分析之外。无论保险状况如何，与基线相比，所有 4 组的 ODI、NRS-BP、NRS-LP 和 EQ-5D 评分均显著改善（P<0.001）。在调整后的多变量分析中，与私人保险患者相比，医疗补助与 24 个月术后 Oswestry 残疾指数（β=10.2；95%置信区间，3.9-16.5；P=0.002）和 NRS 腿痛（β=1.3；95%置信区间，0.3-2.4；P=0.02）更差相关。与私人保险相比，医疗补助与 EuroQol-5D 评分更差（β=-0.07；95%置信区间，-0.01 至-0.14；P=0.03），但与医疗保险和退伍军人事务部/政府保险相比则无差异（P>0.05）。与退伍军人事务部/政府保险相比，医疗补助与 ODI 最小临床重要差异的可能性较低（比值比，0.2；95%置信区间，0.03-0.7；P=0.02）。NRS 腰痛和北美脊柱协会满意度不因保险覆盖范围而不同（P>0.05）。
尽管调整了潜在的混杂变量，但与其他支付类型相比，医疗补助覆盖范围与腰椎滑脱手术后 24 个月的 PRO 较差独立相关。尽管所有患者术后均有所改善，但接受医疗补助的患者改善相对较差。
