TY - JOUR
T1 - Community-level Socioeconomic Status Is a Poor Predictor of Outcomes Following Lumbar and Cervical Spine Surgery
AU - Lambrechts, Mark J.
AU - Issa, Tariq Z.
AU - Lee, Yunsoo
AU - McCurdy, Michael A.
AU - Siegel, Nicholas
AU - Toci, Gregory R.
AU - Sherman, Matthew
AU - Baker, Sydney
AU - Becsey, Alexander
AU - Christianson, Alexander
AU - Nanavati, Ruchir
AU - Canseco, Jose A.
AU - Hilibrand, Alan S.
AU - Vaccaro, Alexander R.
AU - Schroeder, Gregory D.
AU - Kepler, Christopher K.
N1 - Publisher Copyright:
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2025/4
Y1 - 2025/4
N2 - Study Design: Retrospective Cohort study. Objective: Our objective was to compare 3 socioeconomic status (SES) indexes and evaluate associations with outcomes after anterior cervical discectomy and fusion (ACDF) or lumbar fusion. Background Data: Socioeconomic disparities affect patients’ baseline health and clinical outcomes following spine surgery. It is still unclear whether community-level indexes are accurate surrogates for patients’ socioeconomic status (SES) and whether they are predictive of postoperative outcomes. Methods: Adult patients undergoing ACDF (N = 1189) or lumbar fusion (N = 1136) from 2014 to 2020 at an urban tertiary medical center were retrospectively identified. Patient characteristics, patient-reported outcomes (PROMs), and surgical outcomes (90-day readmissions, complications, and nonhome discharge) were collected from the electronic medical record. SES was extracted from 3 indexes (Area Deprivation Index, Social Vulnerability Index, and Distressed Communities Index). Patients were classified into SES quartiles for bivariate and multivariate regression analysis. We utilized Youden’s index to construct receiver operating characteristic curves for all surgical outcomes using indexes as continuous variables. Results: Preoperatively, lumbar fusion patients in the poorest ADI community exhibited the greatest ODI (P = 0.001) and in the poorest DCI and SVI communities exhibited worse VAS back (P < 0.001 and 0.002, respectively). Preoperatively, ACDF patients in the lowest DCI community had significantly worse MCS-12, VAS neck, and NDI, and in the poorest ADI community had worse MCS-12 and NDI. There were no differences in the magnitude of improvement for any PROM. All indexes performed poorly at predicting surgical outcomes (AUC: 0.467-0.636, all P > 0.05). Conclusions: Community-wide SES indexes are not accurate proxies for individual SES. While patients from poorer communities present with worse symptoms, community-level SES is not associated with overall outcomes following spine fusion. Patient-specific factors should be employed when attempting to stratify patients based on SES given the inherent limitations present with these indexes. Level of Evidence: Level III.
AB - Study Design: Retrospective Cohort study. Objective: Our objective was to compare 3 socioeconomic status (SES) indexes and evaluate associations with outcomes after anterior cervical discectomy and fusion (ACDF) or lumbar fusion. Background Data: Socioeconomic disparities affect patients’ baseline health and clinical outcomes following spine surgery. It is still unclear whether community-level indexes are accurate surrogates for patients’ socioeconomic status (SES) and whether they are predictive of postoperative outcomes. Methods: Adult patients undergoing ACDF (N = 1189) or lumbar fusion (N = 1136) from 2014 to 2020 at an urban tertiary medical center were retrospectively identified. Patient characteristics, patient-reported outcomes (PROMs), and surgical outcomes (90-day readmissions, complications, and nonhome discharge) were collected from the electronic medical record. SES was extracted from 3 indexes (Area Deprivation Index, Social Vulnerability Index, and Distressed Communities Index). Patients were classified into SES quartiles for bivariate and multivariate regression analysis. We utilized Youden’s index to construct receiver operating characteristic curves for all surgical outcomes using indexes as continuous variables. Results: Preoperatively, lumbar fusion patients in the poorest ADI community exhibited the greatest ODI (P = 0.001) and in the poorest DCI and SVI communities exhibited worse VAS back (P < 0.001 and 0.002, respectively). Preoperatively, ACDF patients in the lowest DCI community had significantly worse MCS-12, VAS neck, and NDI, and in the poorest ADI community had worse MCS-12 and NDI. There were no differences in the magnitude of improvement for any PROM. All indexes performed poorly at predicting surgical outcomes (AUC: 0.467-0.636, all P > 0.05). Conclusions: Community-wide SES indexes are not accurate proxies for individual SES. While patients from poorer communities present with worse symptoms, community-level SES is not associated with overall outcomes following spine fusion. Patient-specific factors should be employed when attempting to stratify patients based on SES given the inherent limitations present with these indexes. Level of Evidence: Level III.
KW - area deprivation index
KW - cervical spine
KW - disparities
KW - distressed communities index
KW - lumbar spine
KW - patient-reported outcome measures
KW - socioeconomic status
UR - https://www.scopus.com/pages/publications/85212075617
U2 - 10.1097/BSD.0000000000001676
DO - 10.1097/BSD.0000000000001676
M3 - Article
C2 - 39652626
AN - SCOPUS:85212075617
SN - 2380-0186
VL - 38
SP - 132
EP - 140
JO - Clinical spine surgery
JF - Clinical spine surgery
IS - 3
ER -