Racial and Gender Disparities in Clinical Outcomes and Healthcare Cost Among Medicare Beneficiaries Undergoing Lumbar Fusion Surgery

Introduction: Racial and gender disparities in clinical outcomes and healthcare costs are critical issues in neurosurgery. Prior research suggests that racial minorities and women may face higher healthcare costs and extended perioperative care needs. When discussing financial outcomes, many studies contrast patients with commercial insurance with those receiving government-funded insurance. This study investigates associations between race, gender, and perioperative clinical outcomes and healthcare costs amongst Medicare beneficiaries undergoing lumbar fusion surgery.

Methods: A retrospective analysis was conducted using all Medicare patient data from 2018. Patients undergoing lumbar fusion were categorized by race (White, Black or African American, Hispanic, Asian, Native American, Other/Unknown) and gender. Outcomes included discharge disposition, mortality, total charges, daily reimbursable costs, and Medicare entitlement type.

Results: Racial and gender disparities were observed in discharge disposition and cost outcomes. For race-based differences, in terms of discharge disposition, Black (16.5%) and Hispanic (21.2%) patients had higher rates of discharge to skilled nursing or rehabilitation facilities compared to White patients (12.5%) (p < 0.001). Healthcare costs were notably higher for Hispanic patients, who had a mean total charge of $218,080, compared to White patients at $156,545 (p < 0.001).

Gender-based disparities included higher discharge rates to skilled nursing or rehabilitation facilities among female patients (13.7%) than males (11.8%) (p < 0.001), while male patients had a higher mortality rate (0.4%) compared to females (0.2%) (p = 0.005). Male patients also incurred higher total charges (mean $160,051) than females (mean $155,723) (p = 0.019). Lastly, male patients had a higher rate of cost outliers (10.1%) compared to female patients (9.1%) (p = 0.020).

Conclusion : Differences in discharge disposition and cost highlight the need for targeted interventions, even within government-funded programs, to enhance equitable perioperative care and resource allocation across diverse groups.