1382. Differences in Characteristics and Outcomes among Patients Undergoing Surgery for Spondylolisthesis at a Private vs Academic Institution: Analysis from the Quality Outcomes Database

Authors: Mohamad Bydon, MD, FAANS ; Praveen Mummaneni, MD; John Knightly, MD; Kevin Foley, MD; Jonathan Slotkin; Eric Potts, MD; Mark Shaffrey, MD; Michael Wang, MD; Paul Park, MD; Erica Bisson, MD, MPH; Anthony Asher, MD; Christopher Shaffrey, MD (Rochester, MN)

Introduction: Recent healthcare reforms introduced as per the Affordable Care Act (ACA) have emphasized on optimizing the “value” of healthcare which translates into maximizing patient outcomes while containing the cumulative cost of the delivered care. The setting of healthcare delivery has been purported to have an impact on patient outcomes. In the current manuscript, we investigated the differences in outcomes of patients undergoing surgery for spondylolisthesis at a private medical center vs an academic hospital. Methods: The Quality Outcomes Database (QOD) was queried for patients with grade 1 lumbar-spondylolisthesis included in the multi-site QOD study to investigate the impact of fusion on patient reported outcomes (PROs). Patients were divided into private setting and academic setting based on the administrative structure of the institution they received their care at. Results: A total of 797 patients were included in the study, with 40 % (n=318) treated at an academic center and 60% (n=479) treated at a private center. Patients treated at an academic center were more likely to have private insurance (57.9%,n=184 vs 11.3%,n=237, p=0.046), more likely to be Hispanic (10.1%,n=32 vs 1.3%,n=6. P<0.001) more likely to be employed and working (45.3%,n=131 vs 36.7%,n=176, p=0.04), less likely to undergo fusion (75.2%,n=239 vs 83.3%, n=399, p=0.005) and MIS surgery (28.9%, n=92 vs 36.1%, 173, p=0.053). On multivariable analysis, the type of institution was found to have no impact on 1-year and 2-year ODI (Academic vs Private: OR 0.70, 95%CI 0.46-1.05 and OR 0.80, 95%CI 0.53-1.2, respectively) and patient satisfaction at 1 and 2 years (Academic vs Private: OR 1.67, 95%CI 0.66-2.06 and OR 1.01, 95%CI 0.58-1.74 respectively). Conclusion: Our results indicate that even though the baseline patient characteristics and operative characteristics may differ between private and academic centers, both are associated with equivalent clinical and surgical outcomes among patients undergoing surgery for spondylolisthesis.