Posterior spinal fusion (PSF) is the standard surgical treatment for adolescent idiopathic scoliosis (AIS), effectively improving spinal alignment and quality of life. However, disparities in postoperative outcomes related to socioeconomic status, specifically insurance type, remain poorly understood. A retrospective cohort study was conducted using the Nationwide Readmissions Database from 2016 to 2021. Patients aged 10–19 years undergoing PSF for AIS were identified using International Classification of Diseases – Tenth Revision codes. Propensity score matching was performed to control for demographic and clinical factors, yielding 4238 matched pairs of patients with Medicaid and private insurance ( N = 8476). Multivariable logistic regression models were used to assess the association between insurance status and postoperative outcomes. Patients with Medicaid experienced higher 31–90 days readmission rates compared to patients with private insurance (1.49 vs. 0.94%; P = 0.001), while patients with private insurance had a higher overall complication rate (41.76 vs. 36.53%; P < 0.001). Patients with private insurance experienced a greater frequency of short-term complications such as postprocedural pain and intestinal obstruction, whereas patients with Medicaid had higher rates of severe complications such as sepsis (0.50 vs. 0.14%; P = 0.016). Medicaid status remained an independent predictor of long-term readmissions (odds ratio: 1.47, 95% confidence interval: 1.17–1.86, P = 0.001) after adjusting for demographic and clinical factors. Insurance status significantly influences postoperative outcomes following PSF for AIS. Patients with Medicaid are at greater risk for long-term readmissions, while patients with private insurance experience a higher overall complication rate. Level of evidence: Level III, prognostic, case-control study
Dawar et al. (Wed,) studied this question.