title: Medicaid status is associated with higher complication rates after spine surgery.
abstract: METHODS
  Multivariate analysis of prospectively collected registry data.
  
  
  OBJECTIVE
  To determine the effect of payor status on complication rates after spine surgery.
  
  
  BACKGROUND
  Understanding the risk of perioperative complications is an essential aspect in improving patient outcomes. Previous studies have looked at complication rates after spine surgery and factors related to increased perioperative complications. In other areas of medicine, there has been a growing body of evidence gathered to evaluate the role of payor status on outcomes and complications. Several studies have found increased complication rates and inferior outcomes in the uninsured and Medicaid insured.
  
  
  METHODS
  The Spine End Results Registry (2003-2004) is a collection of prospectively collected data on all patients who underwent spine surgery at our 2 institutions. Extensive demographic data, including payor status, and medical information were prospectively recorded as described previously by Mirza et al. Medical complications were defined in detail a priori and were prospectively recorded for at least 2 years after surgery. Using univariate and multivariate analysis, we determined risk of postoperative medical complications dependent on payor status.
  
  
  RESULTS
  A total of 1591 patients underwent spine surgery in 2003 and 2004 that met our criteria and were included in our analysis. With the multivariate analysis and by controlling for age, patients whose insurer was Medicaid had a 1.68 odds ratio (95% confidence interval: 1.23-2.29; P = 0.001) of having any adverse event when compared with the privately insured.
  
  
  CONCLUSIONS
  After univariate and multivariate analyses, Medicaid insurance status was found to be a risk factor for postoperative complications. This corresponds to an ever-growing body of medical literature that has shown similar trends and raises the concern of underinsurance.
authors.affiliation: Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA 98195, USA. jacquesh@uw.edu
authors.forename: Jacques
authors.initials: J
authors.lastname: Hacquebord
authors.forename: Amy M
authors.initials: AM
authors.lastname: Cizik
authors.forename: Sree Harsha
authors.initials: SH
authors.lastname: Malempati
authors.forename: Mark A
authors.initials: MA
authors.lastname: Konodi
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bransford
authors.forename: Carlo
authors.initials: C
authors.lastname: Bellabarba
authors.forename: Jens
authors.initials: J
authors.lastname: Chapman
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D013131:Spine / Q000601:surgery*; D014481:United States / Q000453:epidemiology; D055815:Young Adult