Abstract：
OBJECTIVE: Adolescent idiopathic scoliosis (AIS) is a common spinal deformity affecting pediatric patients, with up to 10% requiring surgical intervention. Studies have shown disparities in these patients associated with race, ethnicity, and insurance type, but there is limited information on disparities that exist based on geographical parameters. In this study, we aim to explore the disparities in the care for AIS by looking at differences in the rates of readmission, infection, and revision between patients residing in rural and urban environments.
METHODS: This is a retrospective cohort study utilizing the Pediatric Health Information System. Pediatric patients that underwent posterior spinal fusion (PSF) for AIS from October 2015 to July 2022 were included. Diagnoses and procedures were identified based on ICD-10 codes and internal tools built into the database. Descriptive statistics were used to summarize the data, including demographics, infection rates, readmission rates, and revision rates. T tests, Chi-squared tests, and logistic regression were used to assess differences between the rural and urban populations. We utilized STATA/SE 15.1 for all data analysis.
RESULTS: 15,318 patients were included in the final cohort. Demographics and baseline characteristics were similar between the rural and urban patients, although more rural patients used Medicaid over commercial insurance (41.5% vs. 32.7%, p < 0.01), median household income was lower in rural patients (p < 0.01), and there was a higher proportion of Hispanic patients in the urban patient cohort (13.9% vs. 6.4%, p < 0.01). Complication rates were not significantly different between the urban and rural patient cohorts, although rural patients did have a significantly higher 90-day readmission rate (7.3% vs. 6.1%, p = 0.03) and higher rates of instrumentation removal (7.7% vs. 4.9%, p = 0.01).
CONCLUSIONS: The surgical outcomes between rural and urban pediatric AIS patients undergoing PSF are comparable, although 90-day readmission rates and rates of instrumentation removal were higher in rural patients. Insurance status is likely a significant driver for the differences observed in this study. Future research is needed to better understand the reasons for these differences and to develop strategies to improve outcomes.
METHODS: Retrospective cohort study, Level III.
METHODS: This is a retrospective cohort study utilizing the Pediatric Health Information System. Pediatric patients that underwent posterior spinal fusion (PSF) for AIS from October 2015 to July 2022 were included. Diagnoses and procedures were identified based on ICD-10 codes and internal tools built into the database. Descriptive statistics were used to summarize the data, including demographics, infection rates, readmission rates, and revision rates. T tests, Chi-squared tests, and logistic regression were used to assess differences between the rural and urban populations. We utilized STATA/SE 15.1 for all data analysis.
RESULTS: 15,318 patients were included in the final cohort. Demographics and baseline characteristics were similar between the rural and urban patients, although more rural patients used Medicaid over commercial insurance (41.5% vs. 32.7%, p < 0.01), median household income was lower in rural patients (p < 0.01), and there was a higher proportion of Hispanic patients in the urban patient cohort (13.9% vs. 6.4%, p < 0.01). Complication rates were not significantly different between the urban and rural patient cohorts, although rural patients did have a significantly higher 90-day readmission rate (7.3% vs. 6.1%, p = 0.03) and higher rates of instrumentation removal (7.7% vs. 4.9%, p = 0.01).
CONCLUSIONS: The surgical outcomes between rural and urban pediatric AIS patients undergoing PSF are comparable, although 90-day readmission rates and rates of instrumentation removal were higher in rural patients. Insurance status is likely a significant driver for the differences observed in this study. Future research is needed to better understand the reasons for these differences and to develop strategies to improve outcomes.
METHODS: Retrospective cohort study, Level III.
摘要：
目的：青少年特发性脊柱侧凸（AIS）是影响儿科患者的常见脊柱畸形，高达10%的人需要手术干预。研究表明，这些患者的差异与种族有关，种族,和保险类型，但是基于地理参数的差异信息有限。在这项研究中,我们的目标是通过观察再入院率的差异来探索AIS护理的差异，感染,以及居住在农村和城市环境中的患者之间的修正。
方法：这是一项利用儿科健康信息系统的回顾性队列研究。纳入2015年10月至2022年7月接受AIS后路脊柱融合术（PSF）的儿科患者。诊断和程序是根据ICD-10代码和数据库内置的内部工具确定的。描述性统计数据被用来总结数据，包括人口统计，感染率,再入院率，和修订率。T测试,卡方检验,和逻辑回归用于评估农村和城市人口之间的差异。我们使用STATA/SE15.1进行所有数据分析。
结果：15,318例患者被纳入最终队列。农村和城市患者的人口统计学和基线特征相似，尽管更多的农村患者使用医疗补助而不是商业保险(41.5%vs.32.7%,p<0.01),农村患者家庭收入中位数较低(p<0.01)，城市患者队列中西班牙裔患者的比例更高(13.9%vs.6.4%,p<0.01)。城乡患者队列的并发症发生率没有显着差异，尽管农村患者的90天再入院率明显更高(7.3%vs.6.1%,p=0.03)和更高的仪器去除率(7.7%与4.9%,p=0.01)。
结论：接受PSF的农村和城市儿科AIS患者的手术结果相当，尽管农村患者的90天再入院率和器械取出率较高.保险状况可能是本研究中观察到的差异的重要驱动因素。未来的研究需要更好地了解这些差异的原因，并制定策略来改善结果。
方法：回顾性队列研究，三级。
方法：这是一项利用儿科健康信息系统的回顾性队列研究。纳入2015年10月至2022年7月接受AIS后路脊柱融合术（PSF）的儿科患者。诊断和程序是根据ICD-10代码和数据库内置的内部工具确定的。描述性统计数据被用来总结数据，包括人口统计，感染率,再入院率，和修订率。T测试,卡方检验,和逻辑回归用于评估农村和城市人口之间的差异。我们使用STATA/SE15.1进行所有数据分析。
结果：15,318例患者被纳入最终队列。农村和城市患者的人口统计学和基线特征相似，尽管更多的农村患者使用医疗补助而不是商业保险(41.5%vs.32.7%,p<0.01),农村患者家庭收入中位数较低(p<0.01)，城市患者队列中西班牙裔患者的比例更高(13.9%vs.6.4%,p<0.01)。城乡患者队列的并发症发生率没有显着差异，尽管农村患者的90天再入院率明显更高(7.3%vs.6.1%,p=0.03)和更高的仪器去除率(7.7%与4.9%,p=0.01)。
结论：接受PSF的农村和城市儿科AIS患者的手术结果相当，尽管农村患者的90天再入院率和器械取出率较高.保险状况可能是本研究中观察到的差异的重要驱动因素。未来的研究需要更好地了解这些差异的原因，并制定策略来改善结果。
方法：回顾性队列研究，三级。
