BACKGROUND Socioeconomic disparities in musculoskeletal care are increasingly recognized, however, no studies to date have investigated the role of the insurance carrier on outcomes after posterior spinal fusion (PSF) with segmental spinal instrumentation for adolescent idiopathic scoliosis (AIS). METHODS A US insurance dataset was queried using the PearlDiver Mariner software for all patients aged 10 to 18 undergoing PSF for a primary diagnosis of AIS between 2010 and 2020. Age, sex, geographic region, number of levels fused, and baseline medical comorbidities were queried. Complications occurring within 90 days of the index surgery were queried using the International Classification of Diseases, Ninth Revision (ICD-9) and International Classification of Diseases, 10th Revision (ICD-10) codes. Revision surgery was also queried up to 5 years after the index PSF. Categorical variables were compared using the Fisher χ 2 tests and continuous variables were compared using independent t tests. All-cause revision within 5 years was compared using the Kaplan-Meier analysis and a log-rank test. Significance was set at P -value <0.05. RESULTS A total of 10,794 patients were identified with 9006 (83.4%) patients with private insurance and 1788 (16.6%) patients insured by Medicaid. The mean follow-up in the database was 5.36±3 years for patients with private insurance and 4.78±2.9 years for patients with Medicaid insurance ( P <0.001). Children with AIS and Medicaid insurance had a significantly higher prevalence of asthma, hypertension, and obesity. A larger percentage of children with Medicaid insurance (41.3%) underwent a ≥13-level PSF compared with privately insured children (34.5%) ( P <0.001). Medicaid patients did not experience higher odds of postoperative complications; in addition, revision surgeries occurred in 1.1% and 1.8% of patients with private insurance and Medicaid insurance, respectively at 5 years postoperatively ( P =0.223). CONCLUSION Despite worse baseline comorbidities and longer fusion constructs, AIS patients insured with Medicaid did not have higher rates of complications or revisions at 5-year follow-up versus privately insured patients. LEVEL OF EVIDENCE Level III-retrospective cohort study.

中文翻译：

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拥有医疗补助保险的儿童在脊柱后融合术 5 年后翻修率是否会增加？

背景 人们越来越认识到肌肉骨骼护理中的社会经济差异，然而，迄今为止还没有研究调查保险公司对青少年特发性脊柱侧凸 (AIS) 节段性脊柱内固定后路脊柱融合 (PSF) 后结果的作用。方法 使用 PearlDiver Mariner 软件查询美国保险数据集，其中包含 2010 年至 2020 年间所有接受 PSF 初步诊断为 AIS 的 10 至 18 岁患者。查询年龄、性别、地理区域、融合级别数以及基线医疗合并症。使用国际疾病分类第九修订版 (ICD-9) 和国际疾病分类第十修订版 (ICD-10) 代码查询索引手术后 90 天内发生的并发症。索引 PSF 后 5 年内还询问了修复手术。使用Fisher χ 2 检验比较分类变量，使用独立t 检验比较连续变量。使用 Kaplan-Meier 分析和对数秩检验比较 5 年内的全因修正。显着性设定为 P 值 <0.05。结果 共有 10,794 名患者被识别，其中 9006 名（83.4%）名患者有私人保险，1788 名（16.6%）名患者有医疗补助保险。数据库中私人保险患者的平均随访时间为 5.36±3 年，医疗补助保险患者的平均随访时间为 4.78±2.9 年（P <0.001）。拥有 AIS 和医疗补助保险的儿童哮喘、高血压和肥胖症的患病率显着较高。与私人保险儿童 (34.5%) 相比，参加医疗补助保险的儿童 (41.3%) 接受 ≥13 级 PSF 的比例更高 ( P <0.001)。接受医疗补助的患者术后并发症的发生率并没有更高；此外，拥有私人保险和医疗补助保险的患者在术后 5 年进行翻修手术的比例分别为 1.1% 和 1.8%（P=0.223）。结论 尽管基线合并症更严重且融合结构更长，但与私人保险患者相比，接受医疗补助保险的 AIS 患者在 5 年随访中并没有出现更高的并发症或翻修率。证据级别 III 级回顾性队列研究。