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Patients’ insurance type, gender, race cited as predictors of surgical approach for CSM
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LAS VEGAS — A study presented here that was designed to identify whether any factors affected the use of an anterior approach for cervical spondylotic myelopathy showed female sex, private insurance status and admission to a non-trauma center were predictors of an anterior-only approach.
Race also had an impact on the type of approach a patient with cervical spondylotic myelopathy (CSM) received, based on a presentation by Shearwood McClelland III, MD, at the International Society for the Advancement of Spine Surgery Annual Meeting,
“Given recent literature demonstrating an increased mortality with posterior-only approaches for CSM, our findings indicate that for these patients, non-Caucasian race may significantly increase mortality risk. The goal and the hope of this study is to provide further impetus for study in this area,” McClelland said.
Some studies have shown the mortality of posterior-only fusion for CSM is about twice that of anterior-only approaches, he noted.
Sherwood McClelland III
McClelland and colleagues used information in the Nationwide Inpatient Sample (NIS) database from 2001 to 2010 to identify 220,746 patients with a diagnosis code of 721.1 for CSM and primary procedure codes that showed they underwent anterior cervical discectomy and fusion, posterior fusion or combined fusion, as well as spinal cord decompression at or below C2. Patients had a mean age of 54 years and most underwent an anterior-only approach. The NIS provided the investigators with information about the patients’ sex, race, insurance status and the type of institutions to which they were admitted.
“Persons with CSM with private insurance were 19% more likely to receive an anterior approach and 17% less likely to receive a posterior approach,” McClelland said.
“On multivariate analysis, we found that there were several factors that reduced the likelihood of receiving an anterior-only approach. One was the upper age and then different racial components, as well — Black race, Hispanic race, Asian Pacific Islander, and then for insurance status: Medicaid insurance, self-pay and no charge. Additional predictors included trauma-center admission type, and admission from court or law enforcement,” he said.
When his paper was discussed, McClelland said the study’s limitations included the accuracy of the overall coding in the NIS database. He also noted use of NIS database was a limitation as key factors related to CSM, such as patients’ preoperative pain scores and radiographic data, could not be assessed. – by Susan M. Rapp
Reference:
McClelland S 3rd, et al. Paper #129. Presented at: International Society for the Advancement of Spine Surgery Annual Meeting; April 6-8, 2016; Las Vegas.
Disclosure: McClelland reports no relevant financial disclosures.