Medical Student Northwestern University Feinberg School of Medicine Chicago, Illinois, United States
Introduction: There has yet to be a detailed analysis of the impact of sociodemographic factors on surgical outcomes for spinal metastases. Given the advanced nature of this pathology, the majority of patients examined had previously established consistent care, allowing for a more direct analysis of sociodemographics on quality of care while at the hospital. We aimed to examine the influence of socioeconomic factors on patients with metastatic spinal tumors.
Methods: We conducted a retrospective chart review of patients undergoing treatment for spinal cord metastases due to various primary cancers. Two hundred and sixty-three patients were identified, and a number of variables including post-treatment complications, length of stay (LOS), readmission, survival, and ZIP code, among others, were collected. Sociodemographic characteristics were then collected and assigned to patients based on their ZIP code. The Chi-square test and the Mann-Whitney-U test were used for binary and continuous variables, respectively. Multivariate regression models were used for further analysis to control for smoking status, age, body mass index (BMI), and Charlson Comorbidity Index (CCI).
Results: Males had significantly lower rates of post-treatment complication compared to females (22.7% versus 39.3%, p=0.0052), and those in zip codes with a high educational attainment had significantly shorter average length of stay compared to those in low percentage zip codes (9.3 days versus 12.2 days, p=0.0058). Multivariate regression revealed that living in a high percentage white zip code and being male significantly decreased risk of post-treatment complication by 19% (p=0.042) and 14% (p=0.032), respectively. Living in a high home value zip code significantly decreased chances of Karnofsky performance score improvement by 23% (p=0.016), and living in a high educational attainment zip code decreased LOS by 3 days (p=0.019).
Conclusion : In patients surgically treated for metastatic spinal tumors, males had significantly lower rates of post-treatment complication. Those in high percentage white areas also had decreased rate of post-treatment complications. Those living in areas with high educational attainment had shorter length of stay. Living in a high home value zip code was counterintuitively associated with decreased chance of KPS improvement.
