Does Age and Medicare Status Affect Clinical Outcomes in Patients Undergoing Anterior Cervical Discectomy and Fusion?

-OBJECTIVE: The objective of this study was to determine if Medicare status and age affect clinical outcomes following anterior cervical discectomy and fusion. -METHODS: Patients who underwent cervical dis-cectomy and fusion between 2014 and 2020 with complete preoperative and 1-year postoperative patient-reported outcome measures (PROMs) were grouped based on Medicare status and age: no Medicare under 65 years (NM < 65), Medicare under 65 years (M < 65), no Medicare 65 years or older (NM 2 65), and Medicare 65 years or older (M 2 65). Multivariate regression for APROMs (A: post-operative minus preoperative) controlled for confounding differences between groups. Significant was set at P < 0.05. -RESULTS: A total of 1288 patients were included, with each group improving in the visual analog score (VAS) Neck (all, P < 0.001), VAS Arm (M < 65: P = 0.003; remaining groups: P< 0.001), and Neck Disability Index (M < 65: P = 0.009; remaining groups: P < 0.001) following surgery. Only M < 65 did not significantly improve in the Physical Component Score (PCS-12) and modified Japa-nese Orthopaedic Association (mJOA) score (P = 0.256 and P = 0.092, respectively). When comparing patients -nder 65 years, non-Medicare patients had better preop-erative PCS-12 (P< 0.001), Neck Disability Index (P< 0.001), and modified Japanese Orthopaedic Association (P < 0.001), as well as better postoperative values for all PROMs (P < 0.001), but there were no differences in APROMs. Multivariate analysis identified M < 65 to be an indepen-dent predictor of decreased improvement in APCS-12 (0 = L4.07, P = 0.015), AVAS Neck (0 = 1.17, P = 0.010), and AVAS Arm (0 = 1.15, P = 0.025) compared to NM < 65. -CONCLUSIONS: Regardless of age and Medicare status, all patients undergoing cervical discectomy and fusion had significant clinical improvement postoperatively. However, Medicare patients under age 65 have a smaller magnitude of improvement in PROMs.