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Medicaid Status Is Associated With Higher Complication Rates After Spine Surgery

Hacquebord, Jacques MD*; Cizik, Amy M. MPH, MS*; Malempati, Sree Harsha MD*; Konodi, Mark A. MS*; Bransford, Richard J. MD; Bellabarba, Carlo MD; Chapman, Jens MD; Lee, Michael J. MD*

doi: 10.1097/BRS.0b013e3182959b68
Health Services Research

Study Design. Multivariate analysis of prospectively collected registry data.

Objective. To determine the effect of payor status on complication rates after spine surgery.

Summary of Background Data. Understanding the risk of perioperative complications is an essential aspect in improving patient outcomes. Previous studies have looked at complication rates after spine surgery and factors related to increased perioperative complications. In other areas of medicine, there has been a growing body of evidence gathered to evaluate the role of payor status on outcomes and complications. Several studies have found increased complication rates and inferior outcomes in the uninsured and Medicaid insured.

Methods. The Spine End Results Registry (2003–2004) is a collection of prospectively collected data on all patients who underwent spine surgery at our 2 institutions. Extensive demographic data, including payor status, and medical information were prospectively recorded as described previously by Mirza et al.16 Medical complications were defined in detail a priori and were prospectively recorded for at least 2 years after surgery. Using univariate and multivariate analysis, we determined risk of postoperative medical complications dependent on payor status.

Results. A total of 1591 patients underwent spine surgery in 2003 and 2004 that met our criteria and were included in our analysis. With the multivariate analysis and by controlling for age, patients whose insurer was Medicaid had a 1.68 odds ratio (95% confidence interval: 1.23–2.29; P = 0.001) of having any adverse event when compared with the privately insured.

Conclusion. After univariate and multivariate analyses, Medicaid insurance status was found to be a risk factor for postoperative complications. This corresponds to an ever-growing body of medical literature that has shown similar trends and raises the concern of underinsurance.

Level of Evidence: 2

Supplemental Digital Content is Available in the Text.Previous studies in other areas of medicine have shown Medicaid insurance as a risk factor for complications and inferior outcomes. This study, a multivariate analysis of 1591 patients having undergone spine surgery, shows an increased perioperative complication rate in Medicaid-insured patients. This raises the growing concern of underinsurance.

*University of Washington; Department of Orthopedics and Sports Medicine, Seattle, WA; and

Harborview Medical Center, Department of Orthopedics and Sports Medicine, Seattle, WA.

Address correspondence and reprint requests to Jacques Hacquebord, MD, 1959 Pacific Ave NE, Box 356500, University of Washington Medical Center, Department of Sports Medicine and Orthopaedic Surgery, Seattle WA 98195; E-mail:

Acknowledgment date: August 9, 2012. First revision date: February 25, 2013. Acceptance date: April 2, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Supported by grants from the NIH/NIAMS 5K23AR48979 and 5P60-AR48093 and supported in part by the Spine End-Results Research Fund at the University of Washington Medical Center through a gift from Synthes Spine (Paoli, PA).

Relevant financial activities outside the submitted work: board membership, consultancy, expert testimony, grants/grants pending, and payment for lectures.

© 2013 by Lippincott Williams & Wilkins