Medicaid status is associated with higher surgical site infection rates after spine surgery.
Medicaid status is associated with higher surgical site infection rates after spine surgery.
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DOI：
10.1097/brs.0000000000000496
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发表时间：
2014-09-15
期刊：
影响因子：
3
通讯作者：
Lee MJ
中科院分区：
文献类型：
--
作者：
Manoso MW;Cizik AM;Bransford RJ;Bellabarba C;Chapman J;Lee MJ
脊柱最终结果登记处（2003-2004 年）是前瞻性收集的所有在华盛顿大学医学中心和港景医疗中心接受脊柱手术的患者数据的登记处。前瞻性收集保险数据并用于多变量分析，以确定围手术期并发症的风险。考虑到手术部位感染的负面财务影响以及具有医疗补助付款人身份的患者总体并发症发生率较高，我们假设医疗补助付款人身份的手术部位感染率会明显更高。医学文献表明，与私人保险相比，拥有公共保险的患者预后较差，并发症发生率较高。没有人表明，与医疗保险和私人保险患者相比，具有医疗补助付款人身份的患者脊柱手术的手术部位感染率显着增加。前瞻性收集的脊柱末端结果登记提供了用于分析的数据。手术部位感染被定义为需要手术清创的治疗。根据手术付款人状况的暴露情况，评估人口、社会、医疗和手术严重程度指数风险因素。人群包括医疗保险 (N=354)、医疗补助 (N=334)、退伍军人管理局 (N=39)、私人保险公司 (N=603) 和自费 (N=42)。与私人投保人相比，保险公司为医疗补助的患者发生手术部位感染的几率为 2.06（95% CI：1.19, 3.58，p=0.01）。该研究强调了随着 2010 年患者保护和平价医疗法案 (PPACA) 的通过，医疗补助患者的脊柱手术费用增加。 PPACA 条款可能会导致医院对医疗补助保险患者的报销费用减少，因为这些患者的并发症发生率较高且费用较高。这个问题可能会无意中导致访问限制。
The Spine End Results Registry (2003-2004) is a registry of prospectively collected data of all patients undergoing spinal surgery at the University of Washington Medical Center and Harborview Medical Center. Insurance data was prospectively collected and used in multivariate analysis to determine risk of perioperative complications. Given the negative financial impact of surgical site infections and the higher overall complication rates of patients with a Medicaid payer status, we hypothesized that a Medicaid payer status would have a significantly higher surgical site infection rate. The medical literature demonstrates lesser outcomes and increased complication rates in patients that have public insurance as compared to private insurance. No one has shown that patients with a Medicaid payer status as compared to Medicare and privately insured patients have a significantly increased surgical site infection rate for spine surgery. The prospectively collected Spine End Results Registry provided data for analysis. Surgical site infection was defined as treatment requiring operative debridement. Demographic, social, medical, and the surgical severity index risk factors were assesses against the exposure of payer status for the surgical procedure. The population included Medicare (N=354), Medicaid (N=334), the Veterans’ Administration (N=39), private insurers (N=603), and self-pay (N=42). Those patients whose insurer was Medicaid had a 2.06 odds (95% CI: 1.19, 3.58, p=0.01) of having a surgical site infection when compared to the privately insured. The study highlights the increased cost of spine surgeries for Medicaid patients with the passage of the Patient Protection and Affordable Care Act of 2010 (PPACA). The PPACA provisions could cause a reduction in re-imbursement to the hospital for taking care of patients with Medicaid insurance due to their higher complication rates and higher costs. This very issue could inadvertently lead to access limitations.