Postdoctoral Fellow Massachusetts General Hospital, Harvard Medical School Boston, Massachusetts, United States
Introduction: Socioeconomic disparities through deprivation and healthcare access remain major public health problems. Although we better understand some of the factors and their impact on neurosurgical outcomes, we have yet to study the impact of neighborhood-level social variables on patient-reported outcomes for lumbar spine surgery. To this end, our study aims to evaluate the impact of area deprivation on the disability and pain of lumbar surgery patients.
Methods: In this multicenter prospective study of adults undergoing spine surgery for lumbar spondylolisthesis in Harvard Medical School-affiliated teaching hospitals, patient-reported outcomes were ascertained between 2015-2022. The area deprivation index (ADI) is a composite measure of social determinants of health composed of 17 US Census indicators, grouped into tertiles, with the highest tertile representing the most socioeconomically disadvantaged group. We used multivariable logistic regression to examine the association between ADI and postoperative outcomes using NIH-PROMIS domains of physical function (PROMIS-PF) and pain interference (PROMIS-PI).
Results: This study included 1,089 patients who underwent surgery for lumbar spondylolisthesis [mean [SD] age, 66.3 [11.1] years; female 630 of 1,089 (58%)]. At baseline, PROMIS-PF and PROMIS-PI were similar across the three groups. After surgery, patients in the highest ADI group reported significantly higher PROMIS-PI (ADI tertile 3; Most deprived; 62.15±6.78; ADI tertile 2; Intermediate; 61.86±6.78; ADI tertile 1; Least deprived; 60.78±6.53; P=0.005). Similarly, patients in the highest deprived group reported significantly lower (PROMIS-PF) indicating increased disability (P=0.01). Regression analysis demonstrated that Black, Indigenous, and People of Color (BIPOC) patients were less likely to reach MCID for PROMIS-PF and PROMIS-PI after controlling for neighborhood-level determinants (White race; Odds ratio; 1.80, 95CI 1.00-3.17; P=0.05).
Conclusion : Individuals living in areas of greater deprivation reported inferior functional and pain outcomes following spine surgery. Socioeconomic differences were considered, yet the odds of postoperative improvement were still considerably lower for patients that were BIPOC. This demonstrates a need for large health systems to understand better the perioperative needs of patients with greater social deprivation and patients of color.
