• Archis R Bhandarkar, Mohammed Ali Alvi, James M Naessens, and Mohamad Bydon.
• Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Alix School of Medicine, Rochester, MN, USA.
• Clin Neurol Neurosurg. 2020 Nov 1; 198: 106223.

IntroductionCharacterizing disparities that exist at safety-net hospitals is crucial for crafting national healthcare reform policies. Healthcare disparities in performing elective neurosurgical procedures like anterior cervical discectomy and fusion (ACDF) at safety-net hospitals have not yet been examined.ObjectiveWe use the National Inpatient Sample (NIS), a national all-payer healthcare database of inpatient admissions, to determine whether safety-net hospitals can provide equitable care after elective ACDF.MethodsThe NIS from 2002 to 2011 was queried for patients who received ACDF in the context of degenerative spine disease. Hospital safety-net burden was designated as low (LBH), medium (MBH), or high (HBH) based on the proportion of inpatient admissions that were billed as Medicaid, self-pay, or charity care. Significance was set at p < 0.001.ResultsA total of 219,433 admissions were included in this analysis. HBHs were more likely than LBHs to treat patients who were Black, Hispanic, on Medicaid, or had myelopathy (p < 0.001). After adjusting for patient, hospital, and clinical factors, treatment at an HBH was associated with greater in-patient inflation-adjusted log cost (p < 0.001), but not with greater length of stay (LOS) (p = 0.04) or odds of an inpatient adverse event like death, incidental durotomy, surgical site infections, deep vein thromboses and others (OR 95 % CI = 0.86-1.42, p = 0.43) compared to LBHs.DiscussionSafety net hospitals had greater inpatient costs, but no greater LOS or odds of inpatient adverse events after elective ACDF. These results demonstrate a need for policies that reduce the cost of performing ACDFs at SNHs.Copyright © 2020 Elsevier B.V. All rights reserved.

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