Surgical Outcomes of Adolescent Idiopathic Scoliosis Patients in the State of California: An Exploration of Practice Patterns

INTRODUCTION: The surgical correction of idiopathic scoliosis is a technically complex procedure that requires significant surgical expertise and highly specialized support. The current study examines practice patterns for the surgical treatment of scoliosis over a 5-year period in the State of California, with particular attention to the effect of payer status on surgical outcomes. Given the significant disparity in reimbursement for scoliosis surgery between patients with different payment sources (i.e. Medicaid versus private insurance), the potential exists for different management of disease and patient outcomes.

METHODS: Using the California Office of Statewide Health Planning and Development (OSHPD) hospital discharge database, data for all surgical discharges between 1993 and 1997 for children ages 10-18 years old with a primary diagnosis of idiopathic scoliosis were reviewed. 1614 children were discharged from 99 hospitals over this period, and form the basis for this report. Outcomes of interest included length of stay (LOS), readmission, death, and need for surgical reoperation.

RESULTS: The mean age at admission of patients was 13.97 years (SD=1.89). The mean LOS was 7.38 days (SD=5.63) and mean readmission rate was 4.5%. Death (n=2) and reoperation (n=4) were extremely uncommon, making it impossible to use these as primary endpoints. Patients insured by Medi-Cal did not have significantly higher readmission rates, but did have a significantly longer length of hospital stay than patients with other payment sources (p<0.001) and had a greater proportion of cases of extreme severity (p<0.05), according to DRG severity code. Patients insured by Medi-Cal also incurred significantly higher hospital charges than patients with other sources of payment (p<0.001).

DISCUSSION AND CONCLUSIONS: The current study highlights the significant disparity in reimbursement rates for scoliosis surgery for patient insured by Medicaid versus private insurance in California. While this study does not address the issue of “unmet need” among the underinsured segment of the population, review of administrative data suggests that patients with Medicaid are more likely to have a higher severity of illness when presenting for surgery, and perhaps as a result, a longer length of stay. Future investigations will seek to reanalyze this dataset in patients with neurogenic scoliosis, where higher mortality and morbidity may allow for a more sensitive analysis of predictors of outcome.