This study aims to evaluate the relationship between age (less than 65) and Medicare status and the success of lumbar fusion. Medicare is accepted by many people in need of spinal surgery, but only if they are 65 or older. Patients under the age of 65 who are covered by Medicare have comparatively less research done on their clinical outcomes.
Electronic health records were queried from patients aged 40 and up who had lumbar fusion surgery between 2014 and 2019. Exclusion criteria included patients who had undergone revision surgeries, had a tumor/infection diagnosis, had more than 2 levels fused, or had more than 3 levels decompressed. Patients were divided into 4 groups, 1 for each Medicare eligibility status: those without Medicare and younger than 65 years old (NM<65), those without Medicare and older than 65 years old (NM≥65), those with Medicare and younger than 65 years old (YM<65), and those with Medicare and older than 65 years old (YM≥65). Based on whether the data was continuous or categorical, T tests or χ2 tests were used to examine the data and draw conclusions about the relationships between the variables.
Controlling for potential confounding factors in multivariate regression for ∆PROMS. A value of 0.05 was chosen for alpha. Of the 1,097 patients, 567 were NM<65 (51.7%), 133 were NM≥65 (12.1%), 42 were YM<65 (3.8%), and 355 were YM≥65 (32.4%). The YM<65 groups had worse preoperative Visual Analog Scale scores (P=0.01), as well as worse pre- and post-surgery Oswestry Disability Index (ODI), Short-Form 12 Mental Component Score (MCS-12), and Physical Component Score (PCS-12). But when comparing YM<65 to YM≥65 and NM<65, regression analysis showed no statistically significant differences in ∆PROMs. The ODI was still lower in the NM<65 than in the YM<65, but the NM<65 was an independent predictor of reduced improvement in the ODI following surgery (β=12.61, P=0.007).
Before and after lumbar fusion surgery, PROMs were considerably lower among Medicare patients under the age of 65. However, with the exception of ∆ODI, which showed greater improvement in Medicare patients younger than 65 compared to non-Medicare patients younger than 65, perioperative improvements were equal between groups.