Comparing Clinical and Patient-Reported Outcomes After Anterior Cervical Discectomy and Fusion Among Patients Aged 65 and Older Based on Insurance Type

STUDY DESIGN: Retrospective cohort. OBJECTIVE: Evaluate the impact of insurance type on outcomes of ACDF among patients 65 years or older. SUMMARY OF BACKGROUND DATA: Despite a 38.7% inflation-adjusted decrease in reimbursement for ACDF procedures in Medicare patients aged 65 years and older over the past decade, ACDF volume has increased by 24%. Value-based care studies have investigated Medicare insurance as a predictor of postoperative outcomes. However, literature examining PROMs by Medicare status, especially for elderly patients, remains limited. METHODS: Patients aged 65 years or older who underwent 1-3 level ACDF (2014-2023) with Medicare, Medicare Advantage, or private insurance were included. Patients were excluded for ACDF performed for trauma/infection/tumor. The area deprivation index (ADI) was used to measure socioeconomic status by ZIP code. Outcomes included 30/90-day readmissions, 1-year reoperations, and PROMs-mental (MCS-12) and physical component summary (PCS-12), visual analog scale (VAS) neck and arm, neck disability index (NDI), and modified Japanese Orthopaedic Association (mJOA) scale. Achievement of the minimum clinically important difference (MCID) was compared between groups. RESULTS: Three hundred three patients were included. Private insurance patients were younger than Medicare (68.8 vs. 71.8 y, P