PMID- 37021755
OWN - NLM
STAT- MEDLINE
DCOM- 20230904
LR  - 20230905
IS  - 1933-0715 (Electronic)
IS  - 1933-0707 (Linking)
VI  - 32
IP  - 3
DP  - 2023 Sep 1
TI  - Impact of insurance status on healthcare resource utilization and outcomes in 
      adolescent patients presenting with spinal cord injuries.
PG  - 294-301
LID - 10.3171/2023.2.PEDS22506 [doi]
AB  - OBJECTIVE: Insurance disparities have been suggested to influence the medical and 
      surgical outcomes of adult patients with spinal cord injury (SCI), with a paucity 
      of studies demonstrating their impact on the outcomes of pediatric and adolescent 
      SCI patients. The aim of this study was to assess the impact of insurance status 
      on healthcare utilization and outcomes in adolescent patients presenting with 
      SCI. METHODS: An administrative database study was performed using the 2017 
      admission year from 753 facilities using the National Trauma Data Bank. 
      Adolescent patients (11-17 years old) with cervical/thoracic SCIs were identified 
      using International Classification of Diseases, Tenth Revision, Clinical 
      Modification coding. Patients were categorized by governmental insurance versus 
      private insurance/self-pay. Patient demographics, comorbidities, imaging, 
      procedures, hospital adverse events (AEs), and length of stay (LOS) data were 
      collected. Multivariate regression analyses were used to determine the effect of 
      insurance status on LOS, any imaging or procedure, or any AE. RESULTS: Of the 488 
      patients identified, 220 (45.1%) held governmental insurance while 268 (54.9%) 
      were privately insured. Age was similar between the cohorts (p = 0.616), with the 
      governmental insurance cohort (GI cohort) having a significantly lower proportion 
      of non-Hispanic White patients than the private insurance cohort (PI cohort) (GI: 
      43.2% vs PI: 72.4%, p < 0.001). While transportation accident was the most common 
      mechanism of injury for both cohorts, assault was significantly greater in the GI 
      cohort (GI: 21.8% vs PI: 3.0%, p < 0.001). A significantly greater proportion of 
      patients in the PI cohort received any imaging (GI: 65.9% vs PI: 75.0%, p = 
      0.028), while there were no significant differences in procedures performed (p = 
      0.069) or hospital AEs (p = 0.386) between the cohorts. The median (IQR) LOS (p = 
      0.186) and discharge disposition (p = 0.302) were similar between the cohorts. On 
      multivariate analysis, with respect to governmental insurance, private insurance 
      was not independently associated with obtaining any imaging (OR 1.38, p = 0.139), 
      undergoing any procedure (OR 1.09, p = 0.721), hospital AEs (OR 1.11, p = 0.709), 
      or LOS (adjusted risk ratio -2.56, p = 0.203). CONCLUSIONS: This study suggests 
      that insurance status may not independently influence healthcare resource 
      utilization and outcomes in adolescent patients presenting with SCIs. Further 
      studies are needed to corroborate these findings.
FAU - Sandhu, Mani Ratnesh S
AU  - Sandhu MRS
AD  - Departments of1Neurosurgery and.
FAU - David, Wyatt B
AU  - David WB
AD  - 2Orthopedics, Yale University School of Medicine, New Haven, Connecticut.
FAU - Reeves, Benjamin C
AU  - Reeves BC
AD  - Departments of1Neurosurgery and.
FAU - Sherman, Josiah J Z
AU  - Sherman JJZ
AD  - Departments of1Neurosurgery and.
FAU - Craft, Samuel
AU  - Craft S
AD  - Departments of1Neurosurgery and.
FAU - Jayaraj, Christina
AU  - Jayaraj C
AD  - Departments of1Neurosurgery and.
FAU - Boroumand, Sam
AU  - Boroumand S
AD  - Departments of1Neurosurgery and.
FAU - Clappier, Mona
AU  - Clappier M
AD  - Departments of1Neurosurgery and.
FAU - Gutierrez, Alan
AU  - Gutierrez A
AD  - Departments of1Neurosurgery and.
FAU - Sarkozy, Margot
AU  - Sarkozy M
AD  - Departments of1Neurosurgery and.
FAU - Koo, Andrew B
AU  - Koo AB
AD  - Departments of1Neurosurgery and.
FAU - Tuason, Dominick A
AU  - Tuason DA
AD  - 2Orthopedics, Yale University School of Medicine, New Haven, Connecticut.
FAU - DiLuna, Michael L
AU  - DiLuna ML
AD  - Departments of1Neurosurgery and.
FAU - Elsamadicy, Aladine A
AU  - Elsamadicy AA
AD  - Departments of1Neurosurgery and.
LA  - eng
PT  - Journal Article
DEP - 20230331
PL  - United States
TA  - J Neurosurg Pediatr
JT  - Journal of neurosurgery. Pediatrics
JID - 101463759
SB  - IM
MH  - Adult
MH  - Humans
MH  - Adolescent
MH  - Child
MH  - *Spinal Cord Injuries/diagnostic imaging/epidemiology/therapy
MH  - Hospitalization
MH  - Length of Stay
MH  - Insurance Coverage
MH  - Patient Acceptance of Health Care
MH  - Retrospective Studies
OTO - NOTNLM
OT  - adolescent spinal cord injury
OT  - healthcare resource utilization
OT  - insurance status
OT  - postoperative outcomes
OT  - spine trauma
EDAT- 2023/04/07 06:00
MHDA- 2023/09/04 06:42
CRDT- 2023/04/06 07:32
PHST- 2022/11/23 00:00 [received]
PHST- 2023/02/23 00:00 [accepted]
PHST- 2023/09/04 06:42 [medline]
PHST- 2023/04/07 06:00 [pubmed]
PHST- 2023/04/06 07:32 [entrez]
AID - 10.3171/2023.2.PEDS22506 [doi]
PST - epublish
SO  - J Neurosurg Pediatr. 2023 Mar 31;32(3):294-301. doi: 10.3171/2023.2.PEDS22506. 
      Print 2023 Sep 1.