Racial disparities in the cost of inpatient spinal cord stimulator surgery among patients in the 2016–2018 National Inpatient Sample

Abstract

IntroductionSpinal cord stimulation is a promising therapy for patients with treatment refractory pain syndromes, and a viable alternative to chronic opioid therapy. Racial disparities are well-documented in the field of pain medicine. This study seeks to determine whether racial disparities are present in spinal cord stimulator (SCS) surgery involving inpatient hospital stays in the United States. ObjectiveThe objective of this study was to analyze the effects of race on health care cost and utilization for patients receiving inpatient SCS surgery. We used total charges incurred by the patient to measure cost and length of stay (LOS) to measures hospital utilization for patients undergoing inpatient SCS surgery. We examined cost and utilization for inpatient surgeries involving SCS insertion, removal, and revision across different race demographics. MethodsThis retrospective cohort study used ICD-10 procedure codes to query for all patients in the 2016–2018 National Inpatient Sample (NIS) who received SCS insertion, removal, and revision surgeries. Univariate analysis was performed in R-studio to assess the relationship between race, LOS, and total charge. Multivariate analysis was also performed in R-studio to adjust for possible confounders. ResultsHispanic race was associated with higher total charge for inpatient SCS surgery (β=+0.29, p = 3.92e-07). Hospital region was also associated with total charge. The South (β=+0.12, p = 3.7e-03) and the West (β=+0.28, p = 3.8e-09) were associated with higher total charge. The linear model also showed that patients with more comorbidities and complex cases paid higher total charges (β=+0.014, p = 6.2e-04). There was no statistically significant difference in LOS between race demographics. ConclusionAfter adjusting for age, gender, type of surgical approach (percutaneous vs. open), household income, insurance coverage, hospital region, and hospital location (urban vs. rural vs. teaching), and comorbidity scores, Hispanic patients had higher total charges for inpatient SCS surgery, but there was no disparity in total charge between white and black patients. White patients were older than minority patients at the time of inpatient SCS surgery.