Resident Physician Yale School of Medicine New Haven, Connecticut, United States
Introduction: Safety Net Hospitals (SNH) serve an especially high proportion of Medicaid, uninsured, and charity care patients. Few have assessed the impact of SNH status on surgical outcomes and healthcare utilization in patients with spinal metastases. The aim of this study was to investigate the impact of SNH status on patient outcomes and healthcare resource utilization in patients undergoing surgical resection of metastatic spinal column tumors.
Methods: A retrospective cohort study was performed using the 2016-2019 National Inpatient Sample database. Adult patients undergoing surgery for spinal metastases were identified using ICD-10-CM codes. Admissions were dichotomized by SNH status, defined as being in the top quartile of Medicaid and uninsured coverage burden. Hospital characteristics, patient demographics, comorbidities, intraoperative variables, and perioperative complications were assessed. Multivariate logistic regression analyses were used to identify independent predictors of extended length of stay (LOS), non-routine discharge, and increased cost.
Results: A total of 11,505 patients were included in this study, of which 24.0% (n=2,760) were treated at a SNH and 76.0% (n=8,745) were treated at a Non-SNH (N-SNH). Comorbidity burden (p=0.324), intraoperative complications (p=0.488) and postoperative complications (p=0.064) were similar between the cohorts. Patients treated at SNH experienced greater LOS compared to patients treated at N-SNH (p < 0.001), though admission costs (p=0.550), non-routine discharge rate (p=0.715) and mortality rate (p=0.629) were similar. On multivariate analysis, SNH was significantly associated with extended LOS [OR: 1.41, p=0.009], but not non-routine discharge disposition [OR: 0.97, p=0.773] or increased cost [OR: 0.93, p=0.655].
Conclusion : Our study suggests that the quality of care provided by SNH is similar to that provided by non-SNH for patients undergoing surgery for spinal metastases, though patient at SNH experience greater LOS.Knowledge of risk factors for suboptimal outcomes following surgery for spinal metastases enables surgeons to optimize outcomes and reduce unnecessary healthcare resource utilization.
