Kumar Neerav, Akosman Izzet, Mortenson Richard, Xu Grace, Kumar Abhinav, Mostafa Evan, Rivlin Jessica, De La Garza Ramos Rafael, Krystal Jonathan, Eleswarapu Ananth, Yassari Reza, Fourman Mitchell S
Weill Cornell School of Medicine, New York, NY, USA.
Duke University, Durham, NC, USA.
N Am Spine Soc J. 2024 Feb 23;17:100315. doi: 10.1016/j.xnsj.2024.100315. eCollection 2024 Mar.
Increasing evidence demonstrates disparities among patients with differing insurance statuses in the field of spine surgery. However, no pooled analyses have performed a robust review characterizing differences in postoperative outcomes among patients with varying insurance types.
A comprehensive literature search of the PUBMED, MEDLINE(R), ERIC, and EMBASE was performed for studies comparing postoperative outcomes in patients with private insurance versus government insurance. Pooled incidence rates and odds ratios were calculated for each outcome and meta-analyses were conducted for 3 perioperative events and 2 types of complications. In addition to pooled analysis, sub-analyses were performed for each outcome in specific government payer statuses.
Thirty-eight studies (5,018,165 total patients) were included. Compared with patients with private insurance, patients with government insurance experienced greater risk of 90-day re-admission (OR 1.84, p<.0001), non-routine discharge (OR 4.40, p<.0001), extended LOS (OR 1.82, p<.0001), any postoperative complication (OR 1.61, p<.0001), and any medical complication (OR 1.93, p<.0001). These differences persisted across outcomes in sub-analyses comparing Medicare or Medicaid to private insurance. Similarly, across all examined outcomes, Medicare patients had a higher risk of experiencing an adverse event compared with non-Medicare patients. Compared with Medicaid patients, Medicare patients were only more likely to experience non-routine discharge (OR 2.68, p=.0007).
Patients with government insurance experience greater likelihood of morbidity across several perioperative outcomes. Additionally, Medicare patients fare worse than non-Medicare patients across outcomes, potentially due to age-based discrimination. Based on these results, it is clear that directed measures should be taken to ensure that underinsured patients receive equal access to resources and quality care.
越来越多的证据表明，脊柱外科领域中不同保险状况的患者之间存在差异。然而，尚无汇总分析对不同保险类型患者的术后结局差异进行全面综述。
对PUBMED、MEDLINE(R)、ERIC和EMBASE进行全面文献检索，以查找比较私人保险患者与政府保险患者术后结局的研究。计算每种结局的汇总发病率和比值比，并对3种围手术期事件和2种并发症类型进行荟萃分析。除汇总分析外，还针对特定政府支付者状况下的每种结局进行了亚组分析。
纳入了38项研究（共5,018,165例患者）。与私人保险患者相比，政府保险患者90天再入院风险更高（比值比1.84，p<0.0001）、非常规出院风险更高（比值比4.40，p<0.0001）、住院时间延长风险更高（比值比1.82，p<0.0001）、任何术后并发症风险更高（比值比1.61，p<0.0001）以及任何医疗并发症风险更高（比值比1.93，p<0.0001）。在将医疗保险或医疗补助与私人保险进行比较的亚组分析中，这些差异在各结局中均持续存在。同样，在所有检查的结局中，医疗保险患者发生不良事件的风险高于非医疗保险患者。与医疗补助患者相比，医疗保险患者仅更有可能经历非常规出院（比值比2.68，p = 0.0007）。
政府保险患者在多个围手术期结局中发生并发症的可能性更大。此外，医疗保险患者在各结局中的情况比非医疗保险患者更差，这可能是由于基于年龄的歧视。基于这些结果，显然应采取针对性措施，以确保保险不足的患者能够平等地获得资源和优质护理。
