Medical Student Warren Alpert Medical School of Brown University
Introduction: Dual-eligible (DE) patients, who are simultaneously enrolled in both Medicare and Medicaid, this population may be at an increased risk for adverse outcomes following spine tumor resection due to their advanced age and lower socioeconomic status.
Methods: We identified all adult admissions undergoing spinal tumor resection from 2002 to 2011 in the National Inpatient Sample (NIS). Admissions were categorized by insurance type: Medicare, Medicaid, DE, private insurance, and self-pay. Multivariable regression adjusted for 21 confounders, including patient, hospital, severity, and tumor characteristics. Outcomes included time from admission to surgery, total length of stay (LOS), inpatient mortality, hospital costs, and discharge disposition.
Results: From 2002-2011, there were a total of 2,292,508 patients admitted with spine tumors, with 73,961 (3.2%) undergoing surgery. Among surgical admissions, 2,455 (3.3%) were DE patients. On average, DE patients (56.3 years) were significantly older than private insurance patients (48.9), self-pay patients (48.5), and Medicaid patients (41.9) were 48.9, 48.5, and 41.9 years old but younger than Medicare patients (71.6; all P< 0.001). Compared to all other insurance groups, DE patients were admitted more often on a non-elective basis (P=0.001) and exhibited greater Risk of Mortality and Severity of Illness scores (P=0.001). Compared to private insurance payers, DE patients experienced a 45.5% longer wait time between admission and surgery (P=0.025), lower odds of routine discharge disposition (OR=0.454, P< 0.001), prolonged LOS (+6.9%, P=0.042), and increased hospitalization costs (+8.3%, P=0.012). DE patients, however, did not experience a statistically significantly higher degree of mortality or complications.
Conclusion : DE patients undergoing spine tumor surgery had increased presenting severity, surgical delays, nonfavorable discharge disposition rates, LOS, and costs. Further research is warranted to improve outcomes for this clinically challenging population.
How to Improve Patient Care: By identifying the variables that impact quality of care for vulnerable patient populations, we can improve outcomes, lower costs, and work towards fostering a more equitable healthcare environment.
