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Topic:

Adolescent Idiopathic Scoliosis

Issue:

Spine

Category:

Developmental

Title:

Socioeconomic, Racial, and Insurance Disparities in Clinical Outcomes After Surgery Among Patients With Idiopathic Scoliosis

Author:

Thornley, Patrick MD; Garner, Sarah; Rogers, Kenneth J. PhD, ATC; Yorgova, Petya MS; Gabos, Peter G. MD; Shah, Suken A. MD

Journal:

Journal of Pediatric Orthopaedics

Date:

February 2024

Reference:

44(2): p e163-e167, DOI: 10.1097/BPO.0000000000002551

Level Of Evidence:

III

# of Patients:

421

Study Type:

Retrospective case-control study

Location:

Single high-volume pediatric spinal deformity institution

Summary:

This study investigates the influence of socioeconomic status (SES), race, and insurance type on clinical outcomes following surgery for idiopathic scoliosis. It analyzes preoperative attendance, likelihood of obtaining second opinions, brace prescriptions, postoperative attendance, emergency visits, and complications within the year following surgery.

Methods:

A retrospective review of clinical data from 421 patients who underwent scoliosis surgery was conducted. The Area Deprivation Index (ADI), a quantitative measure of SES, was used to assess socioeconomic status. Clinical outcomes such as appointment attendance, brace prescription, and complication rates were correlated with ADI, race, and insurance type using χ2 tests (P ≤ 0.05).

Exclusions:

Patients without complete data or who did not undergo surgery were excluded from the study

Results:

Race and SES Influence: Black patients had a higher likelihood of missing preoperative appointments (P = 0.037). Postoperative Appointment Attendance: Patients with lower SES missed more postoperative appointments and were less likely to receive bracing and second opinions (P = 0.038, P = 0.017, P = 0.008, respectively). Insurance and Brace Prescriptions: Black and publicly insured patients had fewer brace prescriptions (P < 0.001, P = 0.050) and were less likely to obtain second opinions (P = 0.004, P = 0.001).

Conclusions:

Caucasian patients, those with private insurance, and those from higher SES backgrounds were more likely to seek preoperative second opinions, be prescribed braces, and attend postoperative appointments. Recognizing and addressing the healthcare disparities related to race, SES, and insurance type is crucial for improving access to scoliosis care for at-risk patient populations.

Relevance:

Limitations:

Perspective:

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