Abstract
It remains unclear how type of insurance coverage impacts long-term, spine-specific patient-reported outcomes (PROs). This study sought to elucidate the impact of insurance on clinical outcomes following lumbar spondylolisthesis surgery.
The prospective Quality Outcomes Database registry was queried for patients with grade 1 degenerative lumbar spondylolisthesis who underwent single-segment surgery. 24-month PROs compared included Oswestry Disability Index (ODI), Numeric Rating Scale Back Pain (NRS-BP), NRS Leg Pain (NRS-LP), EuroQol-5D (EQ-5D), and North American Spine Society (NASS) Satisfaction.
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 VA/government (n=17, 2.8%). 1 patient (0.2%) was uninsured and was removed from the analyses. In adjusted multivariable analyses, when compared to patients with private insurance, Medicaid was associated with worse 24-month postoperative ODI (β=10.2, 95% CI 3.9-16.5) and NRS-LP (β=1.3, 95% CI 0.3-2.4). Medicaid was associated with worse EQ-5D scores compared to private insurance (β=-0.07, 95% CI -0.01--0.14), but not when compared to Medicare and VA/government insurance (p>0.05). Medicaid was associated with lower odds of reaching ODI minimal clinically important difference (OR=0.2, 95% CI 0.03-0.7) compared to VA/government insurance. NRS-BP and NASS 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 following lumbar spondylolisthesis surgery compared to other payer types. While all improved postoperatively, those with Medicaid coverage had relatively inferior improvements.
