TY - JOUR
T1 - Impact of Educational Background on Preoperative Disease Severity and Postoperative Outcomes among Patients with Cervical Spondylotic Myelopathy
AU - Agarwal, Nitin
AU - Digiorgio, Anthony
AU - Michalopoulos, Giorgos D.
AU - Letchuman, Vijay
AU - Chan, Andrew K.
AU - Shabani, Saman
AU - Lavadi, Raj Swaroop
AU - Lu, Daniel C.
AU - Wang, Michael Y.
AU - Haid, Regis W.
AU - Knightly, John J.
AU - Sherrod, Brandon A.
AU - Gottfried, Oren N.
AU - Shaffrey, Christopher I.
AU - Goldberg, Jacob L.
AU - Virk, Michael S.
AU - Hussain, Ibrahim
AU - Glassman, Steven D.
AU - Shaffrey, Mark E.
AU - Park, Paul
AU - Foley, Kevin T.
AU - Pennicooke, Brenton
AU - Coric, Domagoj
AU - Upadhyaya, Cheerag
AU - Potts, Eric A.
AU - Tumialán, Luis M.
AU - Fu, Kai Ming G.
AU - Asher, Anthony L.
AU - Bisson, Erica F.
AU - Chou, Dean
AU - Bydon, Mohamad
AU - Mummaneni, Praveen V.
N1 - Publisher Copyright:
© 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024/4/1
Y1 - 2024/4/1
N2 - Study Design: Retrospective review of a prospectively maintained database. Objective: Assess differences in preoperative status and postoperative outcomes among patients of different educational backgrounds undergoing surgical management of cervical spondylotic myelopathy (CSM). Summary of Background Data: Patient education level (EL) has been suggested to correlate with health literacy, disease perception, socioeconomic status (SES), and access to health care. Methods: The CSM data set of the Quality Outcomes Database (QOD) was queried for patients undergoing surgical management of CSM. EL was grouped as high school or below, graduate-level, and postgraduate level. The association of EL with baseline disease severity (per patient-reported outcome measures), symptoms >3 or ≤3 months, and 24-month patient-reported outcome measures were evaluated. Results: Among 1141 patients with CSM, 509 (44.6%) had an EL of high school or below, 471 (41.3%) had a graduate degree, and 161 (14.1%) had obtained postgraduate education. Lower EL was statistically significantly associated with symptom duration of >3 months (odds ratio=1.68), higher arm pain numeric rating scale (NRS) (coefficient=0.5), and higher neck pain NRS (coefficient=0.79). Patients with postgraduate education had statistically significantly lower Neck Disability Index (NDI) scores (coefficient=-7.17), lower arm pain scores (coefficient=-1), and higher quality-adjusted life-years (QALY) scores (coefficient=0.06). Twenty-four months after surgery, patients of lower EL had higher NDI scores, higher pain NRS scores, and lower QALY scores (P<0.05 in all analyses). Conclusions: Among patients undergoing surgical management for CSM, those reporting a lower educational level tended to present with longer symptom duration, more disease-inflicted disability and pain, and lower QALY scores. As such, patients of a lower EL are a potentially vulnerable subpopulation, and their health literacy and access to care should be prioritized.
AB - Study Design: Retrospective review of a prospectively maintained database. Objective: Assess differences in preoperative status and postoperative outcomes among patients of different educational backgrounds undergoing surgical management of cervical spondylotic myelopathy (CSM). Summary of Background Data: Patient education level (EL) has been suggested to correlate with health literacy, disease perception, socioeconomic status (SES), and access to health care. Methods: The CSM data set of the Quality Outcomes Database (QOD) was queried for patients undergoing surgical management of CSM. EL was grouped as high school or below, graduate-level, and postgraduate level. The association of EL with baseline disease severity (per patient-reported outcome measures), symptoms >3 or ≤3 months, and 24-month patient-reported outcome measures were evaluated. Results: Among 1141 patients with CSM, 509 (44.6%) had an EL of high school or below, 471 (41.3%) had a graduate degree, and 161 (14.1%) had obtained postgraduate education. Lower EL was statistically significantly associated with symptom duration of >3 months (odds ratio=1.68), higher arm pain numeric rating scale (NRS) (coefficient=0.5), and higher neck pain NRS (coefficient=0.79). Patients with postgraduate education had statistically significantly lower Neck Disability Index (NDI) scores (coefficient=-7.17), lower arm pain scores (coefficient=-1), and higher quality-adjusted life-years (QALY) scores (coefficient=0.06). Twenty-four months after surgery, patients of lower EL had higher NDI scores, higher pain NRS scores, and lower QALY scores (P<0.05 in all analyses). Conclusions: Among patients undergoing surgical management for CSM, those reporting a lower educational level tended to present with longer symptom duration, more disease-inflicted disability and pain, and lower QALY scores. As such, patients of a lower EL are a potentially vulnerable subpopulation, and their health literacy and access to care should be prioritized.
KW - cervical spondylotic myelopathy
KW - education
KW - patient-reported outcome measures
UR - http://www.scopus.com/inward/record.url?scp=85189119601&partnerID=8YFLogxK
U2 - 10.1097/BSD.0000000000001557
DO - 10.1097/BSD.0000000000001557
M3 - Article
C2 - 38102749
AN - SCOPUS:85189119601
SN - 2380-0186
VL - 37
SP - E137-E146
JO - Clinical spine surgery
JF - Clinical spine surgery
IS - 3
ER -