(I-572) Does the number of social risk factors affect achieving both minimally clinically important difference in patient-reported outcomes and satisfaction? A QOD study

Introduction: It is unclear whether there is a negative additive effect of social risk factors in patients with cervical spondylotic myelopathy (CSM) from achieving both a minimally clinically important difference (MCID) in outcomes and satisfaction after surgery.

Methods: This was a multi-institutional, retrospective study of the prospective Quality of Outcomes Database Cervical Spondylotic Myelopathy (QOD CSM) registry which included patients of age 18 or older diagnosed with primary CSM who underwent operative management. Social risk factors included race, education, employment, and insurance. Patients were considered to have benefitted from surgery if 1) they reported a score of 1 or 2 on the North American Spine Society (NASS) index and 2) met the MCID in patient-reported outcomes (VAS neck and arm pain, NDI, EQ-5D, or mJOA).

Results: Of the 1,141 patients included in the study, 205 (18.0%) had zero, 347 (30.4%) had one, 334 (29.3%) had two, and 255 (22.3%) had three social risk factors. The 24-month follow-up rate was 87.4% for patient-reported outcomes. After adjusting for all significant covariates, patients with one or more social risk factors were less likely to benefit from surgery in all measured outcomes including neck (OR=0.90, 95% CI=0.83-0.99) and arm (OR=0.88, 95% CI=0.80-0.96) pain, NDI (OR=0.90, 95% CI=0.83-0.98), EQ-5D (OR=0.90, 95% CI=0.83-0.97), and mJOA (OR=0.91, 95% CI=0.84-0.99) (all p< 0.05) compared to those without any risk factors. Patients with two (neck pain OR=0.86, 95% CI=0.77-0.97; arm pain OR=0.81, 95% CI=0.72-0.92; NDI OR=0.84, 95% CI=0.75-0.93; EQ-5D OR=0.81, 95% CI=0.73-0.90; mJOA OR=0.9, 95% CI=0.81-0.997, all p< 0.05) or three (neck pain OR=0.84, 95% CI=0.74-0.95; arm pain OR=0.84, 95% CI=0.74-0.95; NDI OR=0.84, 95% CI=0.74-0.94; EQ-5D OR=0.84, 95% CI=0.75-0.94, all p< 0.05) social risk factors were more likely to fare worse in all outcomes compared to those with only one social risk factor.

Conclusion : Compared to those without any social risk factors, patients who had at least one social risk factor were less likely to achieve MCID and feel satisfied after surgery.

How to Improve Patient Care: The effect of social risk factors is additive in that those with a higher number of risk factors are less likely to benefit compared to those with only one social risk factor.