Mark J Lambrechts, Tariq Z Issa, Yunsoo Lee, Michael A McCurdy, Nicholas Siegel, Gregory R Toci, Matthew Sherman, Sydney Baker, Alexander Becsey, Alexander Christianson, Ruchir Nanavati, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler
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It is still unclear whether community-level indexes are accurate surrogates for patients' socioeconomic status (SES) and whether they are predictive of postoperative outcomes.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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. 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We utilized Youden's index to construct receiver operating characteristic curves for all surgical outcomes using indexes as continuous variables.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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. 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引用次数: 0
摘要
研究设计：回顾性队列研究。目的：我们的目的是比较3个社会经济地位（SES）指标，并评估与前路颈椎椎间盘切除术和融合（ACDF）或腰椎融合后预后的关系。背景数据：社会经济差异影响脊柱手术后患者的基线健康和临床结果。目前尚不清楚社区水平指标是否能准确地替代患者的社会经济地位（SES），以及它们是否能预测术后结果。方法：回顾性分析2014年至2020年在城市三级医疗中心接受ACDF （N=1189）或腰椎融合（N=1136）的成年患者。从电子病历中收集患者特征、患者报告结果（PROMs）和手术结果（90天再入院、并发症和非家庭出院）。SES由3个指数（区域剥夺指数、社会脆弱性指数和贫困社区指数）提取。将患者分为SES四分位数进行双变量和多变量回归分析。我们使用约登指数来构建所有手术结果的接受者操作特征曲线，并将指标作为连续变量。结果：术前，最贫穷的ADI社区的腰椎融合术患者表现出最大的ODI (P=0.001)，最贫穷的DCI和SVI社区的患者表现出更差的VAS back （P0.05）。结论：社会经济状况指数不能准确反映个体的社会经济状况。虽然来自贫困社区的患者表现出更严重的症状，但社区水平的SES与脊柱融合后的总体结果无关。考虑到这些指标固有的局限性，在试图基于SES对患者进行分层时，应采用患者特异性因素。证据等级：三级。
Community-level Socioeconomic Status is a Poor Predictor of Outcomes Following Lumbar and Cervical Spine Surgery.
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.
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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