The Influence of Insurance Status on the Surgical Treatment of Acute XXXX .

@entity1 @entity3510 @entity174 @entity772 @entity1566 @entity130
STUDY DESIGN.: Retrospective propensity score multivariate analysis of the National @entity130 Data Bank (NTDB) between 2008-2011. OBJECTIVE.: To determine the relationship between insurance status and rates of surgery for acute @entity174 with and without @entity1566 ( @entity1566 ). SUMMARY OF BACKGROUND DATA.: The decision for surgery in @entity1 with @entity174 is often based on @entity174 pattern and stability, associated @entity1566 , and the presence of ligamentous and other associated injuries. It is poorly understood how non-clinical factors, such as insurance status, influence the decision for surgical intervention in @entity1 sustaining spinal @entity130 . METHODS.: Using NTDB admission years 2008-2011, we included @entity1 18-64 years old who sustained a @entity174 of the cervical or thoracolumbar spine. @entity1 were excluded if they sustained polytrauma (Injury Severity Score >= 27) or a @entity130 (Abbreviated Injury Scale severity >= 3) to the head, thorax, or abdomen. Our main outcome measure was surgical versus nonsurgical treatment for @entity3510 ; our main predictor was insurance status. Hierarchical multivariate regression analysis and propensity scores were used to determine the relationship between insurance status and surgical treatment, controlling for other factors. We calculated adjusted odds ratios (OR) for rates of surgery. RESULTS.: Our propensity score multivariate analysis demonstrated significantly higher rates of surgery in @entity1 with @entity1566 (OR=11.76, P<0.001), insurance (OR=1.27, P<0.001), white (OR=1.21, P=0.018) versus black race, blunt @entity130 (OR=5.63, P<0.001), shock (OR=1.62, P<0.001), higher Glasgow @entity772 Scale (GCS) score (OR=1.02, P=0.002), transfer from lower acuity hospital (OR=1.51, P<0.001) and treatment at teaching hospitals (OR=1.49, P<0.001). Multivariable subgroup analysis of @entity1566 @entity1 similarly revealed higher surgical rates for insured @entity1 (OR=1.46, P<0.001) compared to those without insurance. CONCLUSIONS.: @entity1 with traumatic spine fractures were more likely to receive surgery if they were insured, regardless of the presence of @entity1566 . LEVEL OF EVIDENCE: 3.
