Safety-Net Hospital Status May Portend Adverse Outcomes Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Introduction: Safety-Net Hospitals (SNHs) provide essential care for many patients with Medicaid or without insurance. The aim of this study was to assess the relationship between SNH status and length of hospital stay (LOS) and costs of admission in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).

Methods: A retrospective cohort study was performed using the 2016–2019 National Inpatient Sample (NIS) database. All adolescent patients (ages 10–17) undergoing PSF for AIS were identified using ICD-10 coding. Patients were stratified by SNH status, defined as hospitals in the top quartile of Medicaid/uninsured patient admissions, while all other hospitals were defined as non-SNHs (N-SNHs).

Results: Of the 13,420 study patients, 8,420 (62.7%) received treatment at N-SNHs and 5,000 (37.3%) at SNHs. The SNH cohort had a significantly greater proportion of Black- and Hispanic-identifying patients (p=0.001), as well as patients with incomes in the bottom two quartiles (p=0.014). A significantly greater proportion of patients in the N-SNH cohort presented with one or more comorbidities (N-SNH: 31.2% vs SNH: 25.6%, p=0.022). The proportions of patients who experienced any AE (p=0.586) or one or more AEs (p=0.368) were similar between cohorts. The SNH cohort had a significantly shorter mean LOS (p=0.015) but significantly greater mean total admission costs (p < 0.001). On multivariate analysis, SNH status was significantly associated with reduced odds of increased LOS [aOR: 0.66, CI (0.50, 0.87), p=0.004] but significantly associated with increased odds of exorbitant costs [aOR: 2.39, CI (1.62, 3.53), p< 0.001].

Conclusion : Our study found that SNH status may influence outcomes in patients undergoing PSF for AIS. Further studies are needed to identify drivers of these disparities to ensure equitable healthcare access and delivery in these vulnerable patient populations.