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Medicaid status is associated with higher surgical site infection rates after spine surgery
Mark W Manoso1, Amy M Cizik, Richard J Bransford
1*Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA †Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; and ‡Department of Orthopedics and Sports Medicine, Harborview Medical Center, Seattle, WA.
Study Design:
The Spine End Results Registry (2003-2004) is a registry of prospectively collected data of all patients undergoing spinal surgery at the University of Washington Medical Center and Harborview Medical Center. Insurance data were prospectively collected and used in multivariate analysis to determine risk of perioperative complications.
Objective:
Given the negative financial impact of surgical site infections (SSIs) and the higher overall complication rates of patients with a Medicaid payer status, we hypothesized that a Medicaid payer status would have a significantly higher SSI rate.
Summary Of Background Data:
The medical literature demonstrates lesser outcomes and increased complication rates in patients who have public insurance than those who have private insurance. No one has shown that patients with a Medicaid payer status compared with Medicare and privately insured patients have a significantly increased SSI rate for spine surgery.
Methods:
The prospectively collected Spine End Results Registry provided data for analysis. SSI was defined as treatment requiring operative debridement. Demographic, social, medical, and the surgical severity index risk factors were assessed against the exposure of payer status for the surgical procedure.
Results:
The population included Medicare (N = 354), Medicaid (N = 334), the Veterans' Administration (N = 39), private insurers (N = 603), and self-pay (N = 42). Those patients whose insurer was Medicaid had a 2.06 odds (95% confidence interval: 1.19-3.58, P = 0.01) of having a SSI compared with the privately insured.
Conclusion:
The study highlights the increased cost of spine surgical procedures for patients with a Medicaid payer status with the passage of the Patient Protection and Affordable Care Act of 2010. The Patient Protection and Affordable Care Act of 2010 provisions could cause a reduction in reimbursement to the hospital for taking care of patients with Medicaid insurance due to their higher complication rates and higher costs. This very issue could inadvertently lead to access limitations.
Level Of Evidence:
3.
Insights
Patients with Medicaid insurance have a significantly higher risk of surgical site infections (SSIs) after spine surgery. This finding highlights potential cost implications and access issues for this patient group.
Area of Science:
- Orthopedic Surgery
- Health Services Research
- Infectious Disease Epidemiology
Background:
- Existing literature indicates poorer outcomes and increased complications for patients with public insurance compared to private insurance.
- However, a specific link between Medicaid payer status and increased surgical site infection (SSI) rates in spine surgery has not been established.
Purpose of the Study:
- To investigate the hypothesis that patients with Medicaid payer status have a significantly higher rate of surgical site infections (SSIs) following spine surgery.
- To determine the financial impact and potential access limitations associated with higher complication rates in this demographic.
Main Methods:
- Analysis of prospectively collected data from the Spine End Results Registry (2003-2004).
- Inclusion of demographic, social, medical, and surgical severity index risk factors.
- Multivariate analysis to assess the risk of perioperative complications, specifically SSIs, against payer status.
Main Results:
- The study included 1672 patients across various insurance types: Medicare (N=354), Medicaid (N=334), Veterans' Administration (N=39), private insurers (N=603), and self-pay (N=42).
- Patients with Medicaid insurance demonstrated a 2.06-fold increased odds of developing an SSI compared to privately insured patients (95% CI: 1.19-3.58, P=0.01).
Conclusions:
- The findings underscore the increased costs associated with spine surgery for patients with Medicaid payer status.
- The Patient Protection and Affordable Care Act of 2010 may lead to reduced hospital reimbursement due to higher complication rates and costs for Medicaid patients.
- This situation could inadvertently create limitations in healthcare access for individuals with Medicaid insurance.
