Department of Orthopaedics, Nemours Children's Health, Wilmington, DE.
J Pediatr Orthop. 2024 Feb 1;44(2):e163-e167. doi: 10.1097/BPO.0000000000002551. Epub 2023 Oct 23.
Socioeconomic status (SES), race, and insurance type correlate with initial curve severity for patients with idiopathic scoliosis, but less is known regarding how these variables impact surgical outcomes. The objectives of this study were to determine the influence of SES, race, and insurance on preoperative appointment attendance, likelihood of obtaining a preoperative second opinion, brace prescription, missed 6 or 12-month postsurgical appointments, incidence of emergency department visits 0 to 90 days after surgery, and major complications within a year of surgery.
A review of 421 patients diagnosed with idiopathic scoliosis who underwent surgery at a single high-volume pediatric spinal deformity institution between May 2015 and October 2021 was conducted. Area Deprivation Index, a quantitative measure of SES, was collected. Scores were stratified by quartile; higher scores indicated a lower SES. χ 2 tests for correlation were performed to determine whether clinical outcomes were dependent upon Area Deprivation Index, race, or insurance type; P ≤0.05 was significant.
The sample was 313 Caucasian (74%), 69 (16%) black, and 39 (9.3%) other patients. More patients had private versus public insurance (80% vs 20%) and were of higher SES. The likelihood of missing preoperative appointments was higher for black patients ( P = 0.037). Those with lower SES missed more postoperative appointments and received less bracing and second opinions ( P = 0.038, P = 0.017, P = 0.008, respectively). Being black and publicly insured correlated with fewer brace prescriptions ( P < 0.001, P = 0.050) and decreased rates of obtaining second opinions ( P = 0.004, P = 0.001).
Patients with idiopathic scoliosis surgery who were Caucasian, privately insured, and of higher SES were more likely to seek preoperative second opinions, be prescribed a brace, and attend postoperative appointments. Recognition of the inherent health care disparities prevalent within each pediatric spine surgery referral region is imperative to better inform local and national institutional level programs to educate and assist patients and families most at risk for disparate access to scoliosis care.
Level III; retrospective case-control study.
社会经济地位（SES）、种族和保险类型与特发性脊柱侧凸患者的初始曲线严重程度相关，但对于这些变量如何影响手术结果知之甚少。本研究的目的是确定 SES、种族和保险对术前预约就诊、获得术前第二意见的可能性、支具处方、错过术后 6 或 12 个月预约、术后 0 至 90 天急诊就诊发生率以及术后 1 年内主要并发症的影响。
对 2015 年 5 月至 2021 年 10 月在一家高容量儿科脊柱畸形机构接受手术的 421 名特发性脊柱侧凸患者进行了回顾性研究。收集了社会经济地位的定量衡量标准——区域贫困指数。分数按四分位数分层；分数越高表示 SES 越低。进行 χ 2 相关性检验，以确定临床结果是否取决于区域贫困指数、种族或保险类型；P ≤0.05 为显著。
样本中 313 例为白种人（74%），69 例为黑种人（16%），39 例为其他种族（9.3%）。与公共保险相比，更多患者拥有私人保险（80%比 20%），SES 也更高。黑人患者错过术前预约的可能性更高（P = 0.037）。SES 较低的患者错过更多术后预约，接受的支具和第二意见较少（P = 0.038、P = 0.017、P = 0.008）。黑人和公共保险与较少的支具处方相关（P < 0.001、P = 0.050），获得第二意见的几率也较低（P = 0.004、P = 0.001）。
接受特发性脊柱侧凸手术的患者中，白种人、私人保险和 SES 较高的患者更有可能寻求术前第二意见、被开具支具处方并参加术后预约。认识到每个儿科脊柱手术转诊区域普遍存在的固有医疗保健差异，对于更好地告知当地和国家机构层面的项目，以教育和帮助最有可能获得脊柱侧凸治疗机会的患者和家庭至关重要。
III 级；回顾性病例对照研究。
