501 Insurance Status Does Not Affect Withdrawal of Life Support or Mortality in Traumatic Spinal Cord Injury: A Propensity Score-Matched Analysis of the Jefferson Population

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INTRODUCTION: Insurance status has been associated with disparities in healthcare access and outcomes, including in the management of traumatic spinal cord injury (SCI). However, whether there is an impact of insurance type in termination of life-supporting treatment (WLST) and mortality in SCI patients has not been clearly defined. METHODS: In this retrospective single-institution study of a quaternary SCI referral center, all patients with acute traumatic SCI treated between January 2021 to July 2024 were reviewed. Patients with Medicare/Medicaid were classified as having public insurance and all other insurance types were categorized as private. Propensity score matching (PSM) was performed to achieve a balanced dataset. Primary outcomes included WLST and mortality, while the need for spine surgery was considered as a secondary outcome. Multivariable logistic regressions were conducted to identify independent predictors for the outcomes of interest. RESULTS: A total of 387 SCI patients were included, the majority of whom had public insurance (n = 272, 70.3%), while 115 (29.7%) had private insurance. Significant differences in baseline characteristics were observed between groups, with several covariates exhibiting imbalance. Age, presenting Glascow coma scale of 3-8 and the need for spine surgery were identified as independent predictors for WLST and mortality. After PSM, 105 eligible pairs were identified, with no remaining differences in baseline characteristics. Mortality and WLST rates did not differ among these groups, either before or after PSM. CONCLUSIONS: In this large quaternary SCI center cohort, insurance type did not appear to be associated with disparities in WLST rates, mortality rates, or the need for spine surgery in patients with acute traumatic spinal cord injury.

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