133SProceedings of the NASS 26th Annual Meeting / The Spine Journal 11 (2011) 1S–173S

regression analysis was performed to analyze the concurrent effects of var-

ious factors on the occurrence of postoperative PE. The threshold for sig-

nificance was a p-value!.05. All statistical analyses were conducted using

the PASWversion 18.0 (SPSS Inc., Chicago, IL, US).

RESULTS: We identified 45,690 eligible patients (21,378 in 2007 and

24,312 in 2008), and the overall incidence of PE after spinal surgery

was 0.08%. Four patients (0.008%) were died with PE. Increased risk

for PE was associated with the aged older than 70 years (p!.007), anesthe-

sia time longer than 360 min (p!.002).

CONCLUSIONS: The main strengths of our study were the number of pa-

tient admissions analayzed and the fact that our data were derived from a na-

tionally representive sample of hosipitals. Several limitations of our study,

however must be acknowledged. Firstly, The present study was based on ret-

rospective observational study, thus, the patient allocation was non-random-

ized. Secondary, we were unable to identify ‘‘non-diagnosed, asymptomatic

PE’’ patients. A third limitation is related to the use of administrative claim

database. Generally, recorded diagnoses in such database are less validated

than those in planned prospective surveys. However, our study produced sev-

eral novel findings, postoperative PE after spinal surgery in JAPAN was es-

timated at 0.08%. Elderly patients (O70 years) and long anesthesia times

(O360 min) appeared to be greater risk for PE.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi: 10.1016/j.spinee.2011.08.322

P21. Does Insurance Status Influence Surgical Outcome for Pediatric

Patients with Idiopathic Scoliosis?

Samuel Cho, MD1, Natalia Egorova, PhD, MPH2, Andrew Hecht, MD3,

Sheeraz Qureshi, MD, MBA4, Alan Moskowitz, MD, FACP5; 1Palisades

Park, NJ, USA; 2Department of Health Evidence and Policy MSSM, New

York, NY, USA; 3New York, NY, USA; 4Mount Sinai School of Medicine,

New York, NY, USA; 5Mount Sinai Medical Center, New York, NY, USA

BACKGROUND CONTEXT: Disparity in healthcare delivery and out-

come exists for various diseases depending on patients’ insurance status

or socioeconomic background. A significant proportion of pediatric pa-

tients who undergo fusion surgery for idiopathic scoliosis do not have pri-

vate insurance and are thus covered by Medicaid.

PURPOSE: To determine whether insurance status influences surgical

outcome for pediatric patients with idiopathic scoliosis.

STUDY DESIGN/SETTING: Retrospective cohort study.

PATIENT SAMPLE: An analysis of the Healthcare Cost and Utilization

Project Kids’ Inpatient Database 2000, 2003, and 2006 was performed. All

patients aged 0 to!18 years with idiopathic scoliosis and no underlying

neurologic disorders who underwent fusion were included.

OUTCOME MEASURES: National trends, patient, hospital and surgical

characteristics, postoperative complications, and risk factorsweredetermined.

METHODS: We used chi-squared test for analysis of categorical vari-

ables, t-test for continuous variables, and logistic regression for multivar-

iate analysis of postoperative complications.

RESULTS: Estimated 5311, 5392, and 5869 fusions were performed for

idiopathic scoliosis in 2000, 2003, and 2006, respectively. Patients with

private insurance were more likely to have surgery than Medicaid patients

(7.44 vs. 5.86 per 100,000 capita). Patients with private insurance were

older than Medicaid patients at the time of surgery (ages !3: 1.8% vs.

6.1%, p!.0001; ages 10-!18: 98.1% vs. 93.6%, p!.0001). Medicaid pa-

tients had higher prevalence of asthma (10.0% vs. 7.2%, p5.0009), hyper-

tension (1.3% vs. 0.2%, p!.0001), diabetes (0.9% vs. 0.3%, p5.002), and

obesity (2.3% vs. 1.3%, p5.0042). Medicaid patients underwent longer fu-

sion (O9 vertebrae: 30.7% vs. 22.9%, p!.0001) and more refusion (1.3%

vs. 0.8%, p5.0492). Postoperative complications were similar, including

death (Medicaid 0.2% vs. Private 0.0%, p5.0639), neurologic (Medicaid

1.8% vs. Private 1.7%, p5.6841) and infectious (Medicaid 0.4% vs. Pri-

vate 0.2%, p5.0993). Length of stay was longer (6.3 vs. 5.7 days,

All referenced figures and tables will be available at the Annual Mee

p!.0001) and hospital charges higher ($82,286 vs. $72,912, p!.0001)

for Medicaid patients. In multivariate analysis, younger age, female gen-

der, and surgery being performed at a children’s hospital in the South or

Midwest were identified as negative predictors, while cardiac disease, obe-

sity, and osteotomies were positive predictors, of developing neurologic

complications

CONCLUSIONS: Medicaid patients had more medical comorbidities and

underwent longer fusions at younger ages for idiopathic scoliosis than pa-

tients with private insurance. However, the rates of postoperative compli-

cations were similar. Pediatric patients with Medicaid who underwent

fusion for idiopathic scoliosis seem to have received similar healthcare

as patients with private insurance.

FDA DEVICE/DRUG STATUS: This abstract does not discuss or include

any applicable devices or drugs.

doi: 10.1016/j.spinee.2011.08.323

P22. The Ability to Work After Short Fusion vs. Long Fusion:

Five-Year Follow-Up

Dennis Crandall, MD1, Kenneth Schmidt, MD2, Jan Revella, RN1,

Michael Chang, MD3, Jason Datta, MD1, Terrence Crowder, MD1,

Dustin Revella4, Ryan McLemore, PhD2; 1Sonoran Spine Center, Mesa,

AZ, USA; 2Banner Good Samaritan Hospital Orthopaedic Residency,

Phoenix, AZ, USA; 3Phoenix, AZ, USA; 4Sonoran Spine Center, Phoenix,

AZ, USA

BACKGROUND CONTEXT: Patients undergoing spinal arthrodesis re-

turn to work with differing regularity, depending on motivation, chronicity,

complications, and other factors. The ability of patients with adult spinal

deformity to return to work and remain working long-term after surgery

has not been well studied.

PURPOSE: Comparison of clinical and radiologic outcomes, complica-

tions, and work status from employed adults undergoing short segment fu-

sions (SSF) vs. long segment fusions (LSF) for deformity in a non-workers

comp cohort.

STUDY DESIGN/SETTING: A retrospective review of prospectively

collected data from a surgical database, and radiographic review.

PATIENT SAMPLE: 100 consecutive patients (39 male, 61 female):

36LSFand 64 SSF,with average age 46 (range 19–60 years)whowerework-

ing before surgery. Excluded: workers compensation, students, unemployed,

retired.

OUTCOME MEASURES: Visual analog scores (VAS) for pain, Oswes-

try disability index (ODI), work status (sedentary, moderate, heavy work),

and pain medication records were followed pre-op and at follow-up.

Patient pain was compared using the sign test. ODI was compared using

paired t-tests, Anderson-Darling was used to verify normalcy. Return to

work rates were compared using Fisher’s Exact Test.

METHODS: LSF diagnoses: idiopathic scoliosis-22, degenerative scolio-

sis-5, kyphosis (Scheuermanns, degenerative, post-traumatic)-9. Length of

fusion for LSF patients averaged 9.6 levels (range 4–15 levels); SSF diag-

noses included degenerative disc disease, stenosis with instability, recur-

rent disc herniation, and spondylolisthesis. SSF patients were fused 1–2

levels only (average 1.4 levels). Clinical and radiologic follow-up was ob-

tained pre-op, and post-op at 1 year, 2 years, and latest follow-up. Work

type was recorded at all intervals and defined: sedentary (!15 lbs lifting),

medium (15–40 lbs lifting), heavy work (O40 lbs lifting).

RESULTS: At average follow-up 70 months (24–106 months), 61 of 64

(95.3%) SSF and 32 of 36 (88.9%) LSF patients were working. Return to

work averaged 25 weeks for LSF, 17 weeks for SSF patients. SSF group

had more pre-op pain and worked more sedentary jobs (61% vs. 39%).

VAS improved for LSF: 5.2pre-op to 2.5 at 2 years (p5.004); SSF: 6.3 pre

to 2.5 at 2 years (p!.001). ODI improved for LSF: 32.4 pre-op to 22.7 at

2 years (p5.0042); SSF improved 44.7 pre-op to 21.3 at 2 years (p!.001).

Pain med use declined for both groups. There was no difference between

SSF and LSF groups in ability to return to work, sedentary/medium/heavy

ting and will be included with the post-meeting online content.