Objective:

We aimed to examine disparities in the access to intraoperative neuromonitoring (IONM) for spinal surgeries and craniotomies via analyzing the National Inpatient Sample (NIS), from 2008-2021. We analyzed disparities in race, income, insurance type, age, geographical location and type of facility. 

Background:

IONM has evolved to become standard of care in some institutions, to help monitor the neural axis integrity during critical procedures. The literature lacks studies examining disparities in the utilization of IONM. Studying disparities in the use of IONM on a national level can help in decisions relating to resource allocation.

Design/Methods:

To evaluate between-IONM differences, unadjusted logistic regression models were estimated. Multivariable models were estimated to adjust for age, comorbidity burden, type of surgery, year of surgery, biological sex, race, insurance, income quartile, geographic region, hospital bed size, and hospital location and teaching status. All analyses accounted for the NIS sampling design with two-tailed p < 0.05 indicating statistical significance.

Results:

We found that patients who underwent craniotomies had lower adjusted of odds of IONM usage if they were more than 60 years of age, male, black, or Hispanic. For spinal surgeries, we found that patients who were non-Hispanic whites, more than 60 years of age, or females had lower adjusted odds of IONM usage. In both types of surgeries, lower income quartile and Medicaid were associated with significantly lower odds of IONM use. In terms of geographical region, the West had more IONM usage compared to the Northeast. The South had significantly lower adjusted odds of IONM usage, while there was no significant difference between the Midwest and Northeast in this regard. 

Conclusions:

We found significant racial, economic, and geographical disparities in the use of IONM. Our findings can be valuable for IONM neurologists, surgeons, healthcare administrators and policymakers alike, and they underscore the need to address these disparities.