title: Differences in treatments and outcomes for idiopathic scoliosis patients treated in the United States from 1998 to 2007: impact of socioeconomic variables and ethnicity.
abstract: BACKGROUND
  Scoliosis is a significant cause of disability and health-care resource utilization in the United States.
  
  
  OBJECTIVE
  Our aim was to evaluate potential disparities in the selection of treatments and outcomes for idiopathic scoliosis patients on a national level. To date, only one study has examined inpatient complications, discharge disposition, and mortality with respect to scoliosis treatment on a national scale.
  
  
  METHODS
  Retrospective review of cases having a primary diagnosis of idiopathic scoliosis using the nationwide inpatient sample (NIS) administrative data from 1998 to 2007.
  
  
  METHODS
  The NIS data were queried to identify patients with a primary diagnosis of idiopathic scoliosis (International Classification of Diseases, Ninth Revision [ICD-9] diagnosis code: 737.30) admitted routinely. Surgically treated patients were identified as those patients who underwent a spinal fusion (ICD-9-Clinical Modification code: 81.08) as a principal procedure.
  
  
  METHODS
  Rates of surgical versus nonsurgical treatments were measured as were inhospital complications and mortality rates.
  
  
  METHODS
  No external funding was received for this work. Univariate and multivariate analyses evaluated race, sex, socioeconomic factors, and hospital characteristics as predictors of surgical versus nonsurgical treatments, as well as inhospital complications and mortality rates.
  
  
  RESULTS
  The study analyzed 9,077 surgically and 1,098 nonsurgically treated patients with idiopathic scoliosis. Univariate analysis showed both patient- and hospital-level variables as strongly associated with surgical versus nonsurgical treatments and outcomes. Multivariate analysis revealed that Caucasians and private insurance patients were more likely to undergo surgical treatment (p<.05) even when controlling for comorbidities. Additionally, Caucasians had a reduced risk of nonroutine discharge compared with non-Caucasians (p=.03). Large hospitals had higher surgery rates (p=.08) than small- or medium-sized facilities and a lower risk of mortality (p=.04). Caucasians (65.1%) were more commonly admitted to large teaching hospitals than African American (59.8%) or Hispanic (41.8%) patients.
  
  
  CONCLUSIONS
  Differences were found in the selection of surgical versus nonsurgical treatments, as well as inhospital morbidity for hospitalized idiopathic scoliosis patients based on ethnic and socioeconomic variables. This may in part be because of differences in access to the resources of large teaching hospitals for different ethnic and socioeconomic groups or variability in severity of scoliosis among these groups that was not captured in this database.
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, 8631 West 3rd St, Suite 800E, Los Angeles, CA 90048, USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Nuño
authors.forename: Doniel G
authors.initials: DG
authors.lastname: Drazin
authors.forename: Frank L
authors.initials: FL
authors.lastname: Acosta
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012600:Scoliosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013123:Spinal Fusion; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States; D044465:White People