P79. Disparities in access to timely spine surgeon evaluation for degenerative lumbar pathology

• Published in: The spine journal 2023-09, Vol.23 (9), p.S145-S145
• Main Authors: Yamaguchi, Karissa, Drolet, Caroline, Hanks, Thomas, Kim, Mary, Shen, Jesse, Nemani, Venu, Leveque, Jean-Christophe, Louie, Philip KH
• Format: Article
• Language: English
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2023.06.304

Some studies have demonstrated the association between race, socioeconomic status (SES), insurance type, and preoperative physical and mental health at presentation in patients indicated for spine surgery. Unfortunately, these factors negatively impact postoperative clinical outcomes and minimal research characterizes how those factors impact patients’ abilities to navigate the health system from initial referral to consultation. This study aims to evaluate the impact of race, SES (measured by the Area Deprivation Index [ADI]), and insurance type on timeliness to a spine surgeon appointment after initial referral; specifically, evaluating patients presenting with symptoms of lumbar radiculopathy. Retrospective observational study approved by the institutional review board (IRB). New patients evaluated for lumbar radiculopathy between March 2021 to September 2021 by four fellowship-trained spine surgeons at a single-center outpatient clinic were included. Patients seen as a part of the Center of Excellence program or for a second opinion were excluded. A review of the electronic medical record and patient-staff communication logs obtained the following variables: Initial referral date, initial spine surgeon visit date, type of visit (virtual vs in-person), symptom duration at presentation, referring provider, referring institution (internal vs external), and referral timing. Demographic data including race, insurance type, zip code of residence, and location of initial consultation were extracted last to avoid bias in the depth of chart review. Multivariable analyses were performed to determine if specific demographic characteristics are associated with prolonged wait times for neurosurgery consultation. Of the 305 new patients seen for initial neurosurgery consultation, 245 met our criteria. In our study, patients with Medicaid experienced significantly longer wait times when compared with patients with Medicare and private insurance (p=0.007). Asian patients experienced the longest mean wait time (mean=59.1 days), followed by White patients (mean=30.6), then Black patients (mean=21.3), but this was not statistically significant (p=0.08). Living in an area of high deprivation was also not associated with significantly prolonged wait times (R=0.025, p=0.696). This study highlighted structural disparities in access to timely neurosurgery evaluation. Our results indicate that a patient's insurance status prolongs wait times for consultation. Further qualitati