{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T19:58:03Z","timestamp":1772827083650,"version":"3.50.1"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Posterior lumbar fusion (PLF) is a routinely used procedure for treatment of spinal pathology. Several studies have highlighted disparities in reoperation and postoperative complications and demonstrated associations between differing insurance providers, complication rates, and hospital resource utilization in spine surgery. Previous studies have examined broad spinal procedures but have not extended to uninsured patients, or adjusted for sociodemographic factors or comorbidity history. Understanding relationships between payor status and outcomes following fusion procedures is vital to promoting healthcare equity. The objective of this study was to assess whether patients\u2019 insurance impacts postoperative outcomes and patient satisfaction following PLF procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The Stanford University Medical Center inpatient registry was used to retrospectively analyze patients who underwent PLF procedures between 2016 and 2022. Propensity score matching was used to compare privately insured with Medicaid patients, as well as comparing uninsured patients with Medicaid patients based on age, sex, and comorbidities. Outcomes data, including 90-day postoperative complications, reoperation, and patient-reported outcome measures scores (Oswestry Disability Index and Patient Health Questionnaire) were collected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 1904 patients fulfilled the inclusion criteria. In unmatched comparisons, statistically significant differences existed within specific types of complications including altered mental status, delirium, neurological complications, and pulmonary complications. A total of 292 privately insured patients were matched to 292 Medicaid patients. Within matched patient groups, the Medicaid group had higher rates of altered mental status (6.2% vs 2.7%, p = 0.042); delirium (9.9% vs 5.1%, p = 0.035); renal dysfunction (6.9% vs 4.1%, p = 0.020); and pulmonary complications (8.9% vs 3.8%, p = 0.049) compared to privately insured patients. Privately insured patients had lower postoperative Oswestry Disability Index scores (30.2 vs 34.4, p = 0.018) compared to Medicaid patients. Following propensity score matching of 88 Medicaid patients to 88 uninsured patients, large but not statistically significant differences existed for neurological complications (12.5% vs 5.7%, p = 0.165) and 5-year revision rates (3.4% vs 1.1%, p = 0.353).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The findings indicate that the treatment outcomes, care quality, and patient satisfaction following PLF procedures differ between Medicaid and privately insured patients. Further investigation is warranted to explore relationships between insurance payor status and clinical outcomes in multicenter populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.9.spine231403","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T20:57:37Z","timestamp":1738357057000},"page":"453-461","source":"Crossref","is-referenced-by-count":0,"title":["Clinical outcomes and patient-reported outcome measures among patients undergoing posterior lumbar fusion procedures with varying insurance payor status: a propensity score\u2013matching study"],"prefix":"10.3171","volume":"42","author":[{"given":"Aaryan","family":"Shah","sequence":"first","affiliation":[{"name":"Neurosurgery Artificial Intelligence Laboratory, Stanford University School of Medicine, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethan","family":"Schonfeld","sequence":"additional","affiliation":[{"name":"Neurosurgery Artificial Intelligence Laboratory, Stanford University School of Medicine, Stanford, California;"},{"name":"Stanford University School of Medicine, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ghani","family":"Haider","sequence":"additional","affiliation":[{"name":"Neurosurgery Artificial Intelligence Laboratory, Stanford University School of Medicine, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neelan J.","family":"Marianayagam","sequence":"additional","affiliation":[{"name":"Neurosurgery Artificial Intelligence Laboratory, Stanford University School of Medicine, Stanford, California;"},{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sina","family":"Sadeghzadeh","sequence":"additional","affiliation":[{"name":"Neurosurgery Artificial Intelligence Laboratory, Stanford University School of Medicine, Stanford, California;"},{"name":"Stanford University School of Medicine, Stanford, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin N.","family":"Stienen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St. Gallen, St. Gallen Medical School, St. Gallen, Switzerland; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anand","family":"Veeravagu","sequence":"additional","affiliation":[{"name":"Neurosurgery Artificial Intelligence Laboratory, Stanford University School of Medicine, Stanford, California;"},{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"J Spine Surg","first-page":"752","article-title":"Trends in lumbar spinal fusion\u2014a literature review","volume":"6","author":"Reisener MJ","year":"2020","unstructured":"Reisener MJ, Pumberger M, Shue J, Girardi FP, Hughes AP. Trends in lumbar spinal fusion\u2014a literature review. J Spine Surg. 2020;6(4):752\u2013761."},{"key":"b2","series-title":"World Neurosurg","first-page":"290","article-title":"Disparities in the surgical treatment of adult spine diseases: a systematic review","volume":"158","author":"Cardinal T","year":"2022","unstructured":"Cardinal T, Bonney PA, Strickland BA,  Disparities in the surgical treatment of adult spine diseases: a systematic review. World Neurosurg. 2022;158:290\u2013304.e1."},{"issue":"24","key":"b3","series-title":"Spine (Phila Pa 1976)","first-page":"2069","article-title":"The effects of hospital and surgeon volume on postoperative complications after LumbarSpine surgery","volume":"36","author":"Farjoodi P","year":"2011","unstructured":"Farjoodi P, Skolasky RL, Riley LH. The effects of hospital and surgeon volume on postoperative complications after LumbarSpine surgery. Spine (Phila Pa 1976). 2011;36(24):2069\u20132075."},{"issue":"4","key":"b4","series-title":"Eur Spine J","first-page":"909","article-title":"The association of regional intensity of neurosurgical care with spinal fusion surgery in the USA","volume":"23","author":"Bekelis K","year":"2014","unstructured":"Bekelis K, Missios S. The association of regional intensity of neurosurgical care with spinal fusion surgery in the USA. Eur Spine J. 2014;23(4):909\u2013915."},{"issue":"3","key":"b5","series-title":"J Am Acad Orthop Surg","first-page":"130","article-title":"Posterior lumbar interbody fusion","volume":"16","author":"DiPaola CP","year":"2008","unstructured":"DiPaola CP, Molinari RW. Posterior lumbar interbody fusion. J Am Acad Orthop Surg. 2008;16(3):130\u2013139."},{"issue":"8","key":"b6","series-title":"Spine J","first-page":"1719","article-title":"Trends in the surgical treatment of lumbar spine disease in the United States","volume":"15","author":"Pannell WC","year":"2015","unstructured":"Pannell WC, Savin DD, Scott TP, Wang JC, Daubs MD. Trends in the surgical treatment of lumbar spine disease in the United States. Spine J. 2015;15(8):1719\u20131727."},{"issue":"5","key":"b7","series-title":"Spine (Phila Pa 1976)","first-page":"369","article-title":"Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015","volume":"44","author":"Martin BI","year":"2019","unstructured":"Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS. Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. Spine (Phila Pa 1976). 2019;44(5):369\u2013376."},{"issue":"11","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"770","article-title":"Disparities in outcomes by insurance payer groups for patients undergoing anterior cervical discectomy and fusion","volume":"45","author":"Rasouli JJ","year":"2020","unstructured":"Rasouli JJ, Neifert SN, Gal JS,  Disparities in outcomes by insurance payer groups for patients undergoing anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 2020;45(11):770\u2013775."},{"issue":"5","key":"b9","series-title":"World Neurosurg","first-page":"459","article-title":"Insurance status and inequalities in outcomes after neurosurgery","volume":"76","author":"El-Sayed AM","year":"2011","unstructured":"El-Sayed AM, Ziewacz JE, Davis MC,  Insurance status and inequalities in outcomes after neurosurgery. World Neurosurg. 2011;76(5):459\u2013466."},{"issue":"10","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"E601","article-title":"Trends and disparities in cervical spine fusion procedures utilization in the New York State","volume":"43","author":"Feng R","year":"2018","unstructured":"Feng R, Finkelstein M, Bilal K, Oermann EK, Palese M, Caridi J. Trends and disparities in cervical spine fusion procedures utilization in the New York State. Spine (Phila Pa 1976). 2018;43(10):E601\u2013E606."},{"issue":"1","key":"b11","series-title":"Int J Equity Health","first-page":"102","article-title":"Frontline perspectives on barriers to care for patients with California Medicaid: a qualitative study","volume":"23","author":"Faiz J","year":"2024","unstructured":"Faiz J, Blegen M, Nu\u00f1ez V,  Frontline perspectives on barriers to care for patients with California Medicaid: a qualitative study. Int J Equity Health. 2024;23(1):102."},{"issue":"9","key":"b12","series-title":"Fed Pract","first-page":"400","article-title":"Reframing clinician distress: moral injury not burnout","volume":"36","author":"Dean W","year":"2019","unstructured":"Dean W, Talbot S, Dean A. Reframing clinician distress: moral injury not burnout. Fed Pract. 2019;36(9):400\u2013402."},{"issue":"4","key":"b13","series-title":"Health Serv Res","first-page":"1347","article-title":"Medicaid expansions from 1997 to 2009 increased coverage and improved access and mental health outcomes for low-income parents","volume":"51","author":"McMorrow S","year":"2016","unstructured":"McMorrow S, Kenney GM, Long SK, Goin DE. Medicaid expansions from 1997 to 2009 increased coverage and improved access and mental health outcomes for low-income parents. Health Serv Res. 2016;51(4):1347\u20131367."},{"issue":"1","key":"b14","series-title":"J Health Econ","first-page":"160","article-title":"Participation and crowd out: assessing the effects of parental Medicaid expansions","volume":"32","author":"Hamersma S","year":"2013","unstructured":"Hamersma S, Kim M. Participation and crowd out: assessing the effects of parental Medicaid expansions. J Health Econ. 2013;32(1):160\u2013171."},{"issue":"5","key":"b15","series-title":"J Health Econ","first-page":"876","article-title":"Family coverage expansions: impact on insurance coverage and health care utilization of parents","volume":"24","author":"Busch SH","year":"2005","unstructured":"Busch SH, Duchovny N. Family coverage expansions: impact on insurance coverage and health care utilization of parents. J Health Econ. 2005;24(5):876\u2013890."},{"issue":"5","key":"b16","series-title":"Neurosurgery","first-page":"746","article-title":"The impact of socioeconomic status on the utilization of spinal imaging","volume":"77","author":"Derakhshan A","year":"2015","unstructured":"Derakhshan A, Miller J, Lubelski D,  The impact of socioeconomic status on the utilization of spinal imaging. Neurosurgery. 2015;77(5):746\u2013754."},{"issue":"4","key":"b1","series-title":"J Spine Surg","first-page":"752","article-title":"Trends in lumbar spinal fusion\u2014a literature review","volume":"6","author":"Reisener MJ","year":"2020","unstructured":"Reisener MJ, Pumberger M, Shue J, Girardi FP, Hughes AP. Trends in lumbar spinal fusion\u2014a literature review. J Spine Surg. 2020;6(4):752\u2013761."},{"key":"b2","series-title":"World Neurosurg","first-page":"290","article-title":"Disparities in the surgical treatment of adult spine diseases: a systematic review","volume":"158","author":"Cardinal T","year":"2022","unstructured":"Cardinal T, Bonney PA, Strickland BA,  Disparities in the surgical treatment of adult spine diseases: a systematic review. World Neurosurg. 2022;158:290\u2013304.e1."},{"issue":"24","key":"b3","series-title":"Spine (Phila Pa 1976)","first-page":"2069","article-title":"The effects of hospital and surgeon volume on postoperative complications after LumbarSpine surgery","volume":"36","author":"Farjoodi P","year":"2011","unstructured":"Farjoodi P, Skolasky RL, Riley LH. The effects of hospital and surgeon volume on postoperative complications after LumbarSpine surgery. Spine (Phila Pa 1976). 2011;36(24):2069\u20132075."},{"issue":"4","key":"b4","series-title":"Eur Spine J","first-page":"909","article-title":"The association of regional intensity of neurosurgical care with spinal fusion surgery in the USA","volume":"23","author":"Bekelis K","year":"2014","unstructured":"Bekelis K, Missios S. The association of regional intensity of neurosurgical care with spinal fusion surgery in the USA. Eur Spine J. 2014;23(4):909\u2013915."},{"issue":"3","key":"b5","series-title":"J Am Acad Orthop Surg","first-page":"130","article-title":"Posterior lumbar interbody fusion","volume":"16","author":"DiPaola CP","year":"2008","unstructured":"DiPaola CP, Molinari RW. Posterior lumbar interbody fusion. J Am Acad Orthop Surg. 2008;16(3):130\u2013139."},{"issue":"8","key":"b6","series-title":"Spine J","first-page":"1719","article-title":"Trends in the surgical treatment of lumbar spine disease in the United States","volume":"15","author":"Pannell WC","year":"2015","unstructured":"Pannell WC, Savin DD, Scott TP, Wang JC, Daubs MD. Trends in the surgical treatment of lumbar spine disease in the United States. Spine J. 2015;15(8):1719\u20131727."},{"issue":"5","key":"b7","series-title":"Spine (Phila Pa 1976)","first-page":"369","article-title":"Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015","volume":"44","author":"Martin BI","year":"2019","unstructured":"Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS. Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. Spine (Phila Pa 1976). 2019;44(5):369\u2013376."},{"issue":"11","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"770","article-title":"Disparities in outcomes by insurance payer groups for patients undergoing anterior cervical discectomy and fusion","volume":"45","author":"Rasouli JJ","year":"2020","unstructured":"Rasouli JJ, Neifert SN, Gal JS,  Disparities in outcomes by insurance payer groups for patients undergoing anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 2020;45(11):770\u2013775."},{"issue":"5","key":"b9","series-title":"World Neurosurg","first-page":"459","article-title":"Insurance status and inequalities in outcomes after neurosurgery","volume":"76","author":"El-Sayed AM","year":"2011","unstructured":"El-Sayed AM, Ziewacz JE, Davis MC,  Insurance status and inequalities in outcomes after neurosurgery. World Neurosurg. 2011;76(5):459\u2013466."},{"issue":"10","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"E601","article-title":"Trends and disparities in cervical spine fusion procedures utilization in the New York State","volume":"43","author":"Feng R","year":"2018","unstructured":"Feng R, Finkelstein M, Bilal K, Oermann EK, Palese M, Caridi J. Trends and disparities in cervical spine fusion procedures utilization in the New York State. Spine (Phila Pa 1976). 2018;43(10):E601\u2013E606."},{"issue":"1","key":"b11","series-title":"Int J Equity Health","first-page":"102","article-title":"Frontline perspectives on barriers to care for patients with California Medicaid: a qualitative study","volume":"23","author":"Faiz J","year":"2024","unstructured":"Faiz J, Blegen M, Nu\u00f1ez V,  Frontline perspectives on barriers to care for patients with California Medicaid: a qualitative study. Int J Equity Health. 2024;23(1):102."},{"issue":"9","key":"b12","series-title":"Fed Pract","first-page":"400","article-title":"Reframing clinician distress: moral injury not burnout","volume":"36","author":"Dean W","year":"2019","unstructured":"Dean W, Talbot S, Dean A. Reframing clinician distress: moral injury not burnout. Fed Pract. 2019;36(9):400\u2013402."},{"issue":"4","key":"b13","series-title":"Health Serv Res","first-page":"1347","article-title":"Medicaid expansions from 1997 to 2009 increased coverage and improved access and mental health outcomes for low-income parents","volume":"51","author":"McMorrow S","year":"2016","unstructured":"McMorrow S, Kenney GM, Long SK, Goin DE. Medicaid expansions from 1997 to 2009 increased coverage and improved access and mental health outcomes for low-income parents. Health Serv Res. 2016;51(4):1347\u20131367."},{"issue":"1","key":"b14","series-title":"J Health Econ","first-page":"160","article-title":"Participation and crowd out: assessing the effects of parental Medicaid expansions","volume":"32","author":"Hamersma S","year":"2013","unstructured":"Hamersma S, Kim M. Participation and crowd out: assessing the effects of parental Medicaid expansions. J Health Econ. 2013;32(1):160\u2013171."},{"issue":"5","key":"b15","series-title":"J Health Econ","first-page":"876","article-title":"Family coverage expansions: impact on insurance coverage and health care utilization of parents","volume":"24","author":"Busch SH","year":"2005","unstructured":"Busch SH, Duchovny N. Family coverage expansions: impact on insurance coverage and health care utilization of parents. J Health Econ. 2005;24(5):876\u2013890."},{"issue":"5","key":"b16","series-title":"Neurosurgery","first-page":"746","article-title":"The impact of socioeconomic status on the utilization of spinal imaging","volume":"77","author":"Derakhshan A","year":"2015","unstructured":"Derakhshan A, Miller J, Lubelski D,  The impact of socioeconomic status on the utilization of spinal imaging. 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