138 - Impact of Educational Background on Preoperative Disease Severity and Postoperative Outcomes among Patients with Lumbar Spondylolisthesis: A Quality Outcomes Database (QOD) Study

Saturday, June 3, 2023

11:54 AM – 11:56 AM

Location: Salons 13-15

Co-Author(s)

NA

Nitin Agarwal, M.D.

University of Pittsburgh Medical Center, United States

Co-Author(s)

AC

Andrew K. Chan, MD

Assistant Professor of Neurological Surgery (in Orthopaedic Surgery)
Columbia University
New York, New York, United States
MB

Mohamad Bydon, MD

Rochester, Minnesota, United States
EB

Erica F. Bisson, MD, MPH

Utah, United States
Steven D. Glassman, MD

Medical Director
Norton Leatherman Spine Center
Louisville, Kentucky, United States
KF

Kevin T. Foley, MD

United States
CS

Christopher I. Shaffrey, Sr., MD

Duke University Medical Center
Durham, North Carolina, United States
OG

Oren N. Gottfried, M.D.

Author
Duke University Medical Center, United States
LT

Luis M. Tumialán, M.D.

Barrow Neurological Institute, United States
EP

Eric A. Potts, MD

United States
MS

Mark E. Shaffrey, MD

United States
DC

Domagoj Coric, MD

Neurosurgeon
Carolina Neurosurgery and Spine Associates
Charlotte, North Carolina, United States
JK

John J. Knightly, MD

New Jersey, United States
GM

Giorgos D. Michalopoulos, MD

Minnesota, United States

Presenting Author (Person doing the Podium Present(s)

RL

Raj S. Lavadi, M.B.B.S.

Washington University School of Medicine in St. Louis, United States

Co-Author(s)

PP

Paul Park, MD

United States
MW

Michael Y. Wang, MD

Professor
University of Miami Department of Neurosurgery
Miami, Florida, United States
KF

Kai-Ming Fu, M.D., Ph.D.

Weil Cornell Medical Center, United States
JS

Jonathan R. Slotkin, MD

United States
AA

Anthony L. Asher, MD

Carolina Neurosurgery and Spine Associates, United States
MV

Michael S. Virk, MD, PhD

United States
JG

Jian Guan, MD

United States
RH

Regis W. Haid, Jr., n/a

Atlanta Brain and Spine Care
Atlanta, Georgia, United States
DC

Dean Chou, MD

Columbia University, United States
PM

Praveen V. Mummaneni, MD, MBA

Professor
University of California San Francisco
san francisco, California, United States

Submitter(s)

NA

Nitin Agarwal, M.D.

University of Pittsburgh Medical Center, United States

Introduction: Patient education has been correlated with increased disease-related morbidity and decreased access to care. However, the associations between educational level, preoperative disease severity, and postoperative outcomes in patients with lumbar spondylolisthesis have yet to be explored.

Aims/

Objectives: To explore the associations between educational level, preoperative disease severity, and postoperative outcomes in patients with lumbar spondylolisthesis.

Methods: The spondylolisthesis dataset of the Quality Outcomes Database (QOD) – a cohort with prospectively collected data and up to five years of follow-up – was utilized and stratified for educational level. Patients were classified into three categories based on their level of education (i.e., high school or below, graduate, postgraduate). Patient-reported outcome measures (PROMs) documented at baseline and follow-up included the Oswestry Disability Index (ODI), EuroQol-5D (EQ-5D) in quality-adjusted life years (QALY), and the Numerical Rating Scale (NRS) for back and leg pain. The PROMs ascertained equated to disease severity. Postoperatively, patients also completed the North American Spine Society 1-2 (NASS 1-2) to measure their satisfaction with surgery. Multivariable regression analysis was used to compare education level with disease severity.

Results: Six hundred and eight patients were included for analysis, of which 260 (42.8%) patients had an educational level of high school or below. Patients with a lower educational level were of lower socioeconomic status and were more likely to present with both back and leg pain. As illustrated in the Figure, educational level correlated negatively with baseline disease severity as indicated by ODI, EQ-5D (in QALY), NRS leg and back pain scores. Educational level was an independent predictor of worse ODI (coefficient = 3.72, p = 0.046) and back pain NRS (coefficient = 0.51, p = 0.039) scores at baseline. Five years after surgery, patients of different educational backgrounds had similar rates of minimal clinically important difference in PROMs, but discrepancies between different educational levels were prevalent in final PROMs.

Conclusions: Lower patient education level is associated with a greater baseline disease severity in patients with lumbar spondylolisthesis. Patients benefit from surgery equally across different educational backgrounds, yet patients of high school or below educational level have worse long-term outcomes due to their greater disease severity at baseline.