LAUSR

STUDY DESIGN Retrospective, observational study of clinical outcomes at a single institution. OBJECTIVE To compare postoperative complication and readmission rates of payer groups in a cohort of patients undergoing anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA Studies examining associations between primary payer and outcomes in spine surgery have been equivocal. METHODS Patients at Mount Sinai having undergone ACDF from 2008-2016 were queried and assigned to one of five insurance categories: uninsured, managed care, commercial indemnity insurance, Medicare, and Medicaid, with patients in the commercial indemnity group serving as the reference cohort. Multivariable logistic regression equations for various outcomes with the exposure of payer were created, controlling for age, sex, ASA Class, the Elixhauser Comorbidity Index, and number of segments fused. A Bonferroni correction was utilized, such that alpha= 0.0125. RESULTS 2,387 patients underwent ACDF during the time period. Both Medicare (p < 0.0001) and Medicaid (p < 0.0001) patients had higher comorbidity burdens than commercial patients when examining ASA Class. Managed care (2.86 vs. 2.72, p = 0.0009) and Medicare patients (2.99 vs. 2.72, p < 0.0001) had more segments fused on average than commercial patients. Medicaid patients had higher rates of prolonged extubation (Odds ratio [OR]: 4.99; 95% Confidence Interval [CI]: 1.13-22.0; p = 0.007), and Medicare patients had higher rates of prolonged LOS (OR: 2.44, 95% CI: 1.13-5.27%, p = 0.004) than the commercial patients. Medicaid patients had higher rates of 30- (OR: 4.12; 95% CI: 1.43-11.93; p = 0.0009) and 90-day (OR: 3.28; 95% CI: 1.34-8.03; p = 0.0009) ED visits than the commercial patients, and managed care patients had higher rates of 30-day readmission (OR: 3.41; 95% CI: 1.00-11.57; p = 0.0123). CONCLUSIONS Medicare and Medicaid patients had higher rates of prolonged LOS and postoperative ED visits, respectively, compared to commercial patients. LEVEL OF EVIDENCE 3.