Introduction: There has been a steady increase in spinal fusion procedures performed each year in the US, especially cervical and lumbar fusion. Our study aims to analyze the rate of increase at low-, medium-, and high-volume hospitals, and socioeconomic characteristics of the patient populations at these three volume categories.
Methods: We searched the New York State, Statewide Planning and Research Cooperative System (SPARCS) database from 2005 to 2014 for the ICD-9-CM Procedure Codes 81.01 (Fusion, atlas-axis), 81.02 (Fusion, anterior column, other cervical, anterior technique), and 81.03 (Fusion, posterior column, other cervical, posterior technique). Patients’ primary diagnosis (ICD-9-CM), age, race/ethnicity, primary payment method, severity of illness, length of stay, hospital of operation were included. We categorized all 122 hospitals high-, medium-, and low-volume. We then described the trends in annual number of cervical spine fusion surgeries in each of the three hospital volume groups using descriptive statistics.
Results: African American patients were significantly greater portion of patients receiving care at low-volume hospitals, 15.1% versus 11.6% at high-volume hospital. Medicaid and self-pay patients were also overrepresented at low-volume centers, 6.7% and 3.9% versus 2.6% and 1.7% respectively at high-volume centers. In addition, Compared with Caucasian patients, African American patients had higher rates of post-operative infection (p = 0.0020) and post-operative bleeding (p = 0.0044). Compared with privately insured patients, Medicaid patients had a higher rate of post-operative bleeding (p = 0.0266) and in-hospital mortality (p = 0.0031).
Conclusions: Our results showed significant differences in racial distribution and primary payments methods between the low- and high-volume categories, and suggests that accessibility to care at high-volume centers remains problematic for these disadvantaged populations.
Patient Care: Our study bring awareness to the racial/ethnic and socioeconomic disparities to access high quality care for cervical spine fusion procedures.
Learning Objectives: 1. Number of cervical spine fusion procedures continues to increase each year.
2. There are significant disparities in racial distribution and primary payments methods between the low- and high-volume hospitals.
3. Accessibility to care at high-volume centers remains problematic for these disadvantaged populations.