Publication:

Impact of the COVID-19 pandemic on prior authorization delays for lumbar surgery: a retrospective cohort study

Background The objective of this study was to evaluate the impact of the COVID-19 pandemic on prior authorization (PA) delays for lumbar surgery and to assess whether these changes varied by insurance type and patient demographics.

Methods A retrospective cohort study comparing lumbar surgery patients treated before the COVID-19 pandemic (2017-2018) and after the pandemic (2022–2023). We reviewed 400 patient charts from Alpine Ortho spine clinic database in Eastern Washington, of which 363 met inclusion criteria. Eligible patients had documentation of preoperative clinic visit, PA request, and lumbar surgery as defined by CPT codes. Demographics, comorbidities, payer type, and surgical details were extracted from electronic medical records. For Medicare patients, who do not require PA, the interval from preoperative clinic visit to surgery was used for consistency. The primary outcome was time from PA request to surgery. Statistical analysis was performed using two-way ANOVA with Tukey’s HSD for post-hoc comparisons.

Results The mean PA interval increased from 38.7±14.2 days in 2017-2018 to 60.4±15.8 days in 2022-2023 (p< 0.001). Female patients in 2022-2023 experienced longer delays (62.0 ± 15.1 days) than males (58.5±16.3 days, p=0.03). Across payer types, Medicaid patients waited the longest. In 2022-2023, Medicaid patients waited 66.7±15.6 days, Private patients 53.9±14.9 days, and Medicare patients 61.5±15.2 days.

Conclusions PA delays for lumbar surgery significantly worsened following COVID-19, with disproportionate impacts on Medicaid and Medicare patients.