TY - JOUR
T1 - Disparities in inpatient costs and outcomes after elective anterior cervical discectomy and fusion at safety-net hospitals
AU - Bhandarkar, Archis R.
AU - Alvi, Mohammed Ali
AU - Naessens, James M.
AU - Bydon, Mohamad
N1 - Publisher Copyright:
© 2020
PY - 2020/11
Y1 - 2020/11
N2 - Introduction: Characterizing disparities that exist at safety-net hospitals is crucial for crafting national healthcare reform policies. Healthcare disparities in performing elective neurosurgical procedures like anterior cervical discectomy and fusion (ACDF) at safety-net hospitals have not yet been examined. Objective: We use the National Inpatient Sample (NIS), a national all-payer healthcare database of inpatient admissions, to determine whether safety-net hospitals can provide equitable care after elective ACDF. Methods: The NIS from 2002 to 2011 was queried for patients who received ACDF in the context of degenerative spine disease. Hospital safety-net burden was designated as low (LBH), medium (MBH), or high (HBH) based on the proportion of inpatient admissions that were billed as Medicaid, self-pay, or charity care. Significance was set at p < 0.001. Results: A total of 219,433 admissions were included in this analysis. HBHs were more likely than LBHs to treat patients who were Black, Hispanic, on Medicaid, or had myelopathy (p < 0.001). After adjusting for patient, hospital, and clinical factors, treatment at an HBH was associated with greater in-patient inflation-adjusted log cost (p < 0.001), but not with greater length of stay (LOS) (p = 0.04) or odds of an inpatient adverse event like death, incidental durotomy, surgical site infections, deep vein thromboses and others (OR 95 % CI = 0.86−1.42, p = 0.43) compared to LBHs. Discussion: Safety net hospitals had greater inpatient costs, but no greater LOS or odds of inpatient adverse events after elective ACDF. These results demonstrate a need for policies that reduce the cost of performing ACDFs at SNHs.
AB - Introduction: Characterizing disparities that exist at safety-net hospitals is crucial for crafting national healthcare reform policies. Healthcare disparities in performing elective neurosurgical procedures like anterior cervical discectomy and fusion (ACDF) at safety-net hospitals have not yet been examined. Objective: We use the National Inpatient Sample (NIS), a national all-payer healthcare database of inpatient admissions, to determine whether safety-net hospitals can provide equitable care after elective ACDF. Methods: The NIS from 2002 to 2011 was queried for patients who received ACDF in the context of degenerative spine disease. Hospital safety-net burden was designated as low (LBH), medium (MBH), or high (HBH) based on the proportion of inpatient admissions that were billed as Medicaid, self-pay, or charity care. Significance was set at p < 0.001. Results: A total of 219,433 admissions were included in this analysis. HBHs were more likely than LBHs to treat patients who were Black, Hispanic, on Medicaid, or had myelopathy (p < 0.001). After adjusting for patient, hospital, and clinical factors, treatment at an HBH was associated with greater in-patient inflation-adjusted log cost (p < 0.001), but not with greater length of stay (LOS) (p = 0.04) or odds of an inpatient adverse event like death, incidental durotomy, surgical site infections, deep vein thromboses and others (OR 95 % CI = 0.86−1.42, p = 0.43) compared to LBHs. Discussion: Safety net hospitals had greater inpatient costs, but no greater LOS or odds of inpatient adverse events after elective ACDF. These results demonstrate a need for policies that reduce the cost of performing ACDFs at SNHs.
KW - Elective ACDF
KW - Health policy
KW - Safety-net hospitals
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U2 - 10.1016/j.clineuro.2020.106223
DO - 10.1016/j.clineuro.2020.106223
M3 - Article
C2 - 32942136
AN - SCOPUS:85090737803
SN - 0303-8467
VL - 198
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
M1 - 106223
ER -