Neighborhood-level socioeconomic status, extended length of stay, and discharge disposition following elective lumbar spine surgery

Hagan, Matthew; Sastry, Rahul; Feler, Joshua; Abdulrazeq, Hael; Sullivan, Patricia Zadnik; Abinader, Jose Fernandez; Camara, Joaquin Q.; Niu, Tianyi; Fridley, Jared; Oyelese, Adetokunbo A.; Sampath, Prakash; Telfeian, Albert E.; Gokaslan, Ziya L.; Toms, Steven; Weil, Robert J.

doi:10.1016/j.xnsj.2022.100187

Cited by 4 publications

(6 citation statements)

References 56 publications

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“…Prior studies have corroborated our findings that the most disadvantaged ADI cohort had a greater proportion of patients who self-identified as Black and had a prolonged length of stay 14,36,37 . We found that patients from less disadvantaged backgrounds had a significantly higher likelihood of being discharged to a resource-intensive destination compared with their counterparts, who were more likely to be discharged home.…”

Section: Discussionsupporting

confidence: 88%

“…For example, race is often stratified into subgroups with which the patient may not identify, leading to inaccurate conclusions 27,28 . However, the ADI incorporates 17 socioeconomic features such as education, transportation access, and neighborhood violence into a single normalized score that is continuously updated [11][12][13][14] . Our study highlights the value of the ADI over individualized social determinants of health: Our most deprived cohort did possess lower mean household income, but that did not predict length of stay or discharge destination.…”

Section: Discussionmentioning

confidence: 99%

“…able to demonstrate relationships between socioeconomically disadvantaged neighborhoods and outcomes such as length of stay and discharge destination 14 .…”

mentioning

confidence: 99%

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Increased Neighborhood Deprivation Is Associated with Prolonged Hospital Stays After Surgical Fixation of Traumatic Pelvic Ring Injuries

Patel,

Shaikh,

Brodell

et al. 2023

Journal of Bone and Joint Surgery

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Background: The purpose of this study was to understand the role of social determinants of health assessed by the Area Deprivation Index (ADI) on hospital length of stay and discharge destination following surgical fixation of pelvic ring fractures. Methods: A retrospective chart analysis was performed for all patients who presented to our level-I trauma center with pelvic ring injuries that were treated with surgical fixation. Social determinants of health were determined via use of the ADI, a comprehensive metric of socioeconomic status, education, income, employment, and housing quality. ADI values range from 0 to 100 and are normalized to a U.S. mean of 50, with higher scores representing greater social deprivation. We stratified our cohort into 4 ADI quartiles. Statistical analysis was performed on the bottom (25th percentile and below, least deprived) and top (75th percentile and above, most deprived) ADI quartiles. Significance was set at p < 0.05. Results: There were 134 patients who met the inclusion criteria. Patients in the most deprived group were significantly more likely to have a history of smoking, to self-identify as Black, and to have a lower mean household income (p = 0.001). The most deprived ADI quartile had a significantly longer mean length of stay (and standard deviation) (19.2 ± 19 days) compared with the least deprived ADI quartile (14.7 ± 11 days) (p = 0.04). The least deprived quartile had a significantly higher percentage of patients who were discharged to a resource-intensive skilled nursing facility or inpatient rehabilitation facility compared with those in the most deprived quartile (p = 0.04). Race, insurance, and income were not significant predictors of discharge destination or hospital length of stay. Conclusions: Patients facing greater social determinants of health had longer hospital stays and were less likely to be discharged to resource-intensive facilities when compared with patients of lesser social deprivation. This may be due to socioeconomic barriers that limit access to such facilities. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Increased Neighborhood Deprivation Is Associated with Prolonged Hospital Stays After Surgical Fixation of Traumatic Pelvic Ring Injuries

Patel,

Shaikh,

Brodell

et al. 2023

Journal of Bone and Joint Surgery

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“…Finally, spine-related interventions, such as lumbar fusion, have been associated with a plethora of perioperative and postoperative complications, especially with an increased comorbidity index, which could further hinder economic ability and recovery in patient populations with higher ADIs 21–23 . Although the risks for complications and other postsurgical outcomes have been well documented, with subsequent increases in the prevalence of lumbar fusions, there is a scarcity of research evaluating the impact ADI and SES on patients with degenerative spine conditions undergoing primary 1- to 2-level lumbar fusion (1-2LF) 24,25 …”

mentioning

confidence: 99%

“…[21][22][23] Although the risks for complications and other postsurgical outcomes have been well documented, with subsequent increases in the prevalence of lumbar fusions, there is a scarcity of research evaluating the impact ADI and SES on patients with degenerative spine conditions undergoing primary 1-to 2-level lumbar fusion (1-2LF). 24,25 Therefore, the aims of this study were to determine whether patients with high ADIs undergoing primary 1-2LF is associated with differences in (1) medical complications, (2) emergency department (ED) utilization, (3) readmission rates, and (4) costs of care.…”

mentioning

confidence: 99%

Lower Neighborhood Socioeconomic Status May Influence Medical Complications, Emergency Department Utilization, and Costs of Care After 1-2 Level Lumbar Fusion

Gordon

Elali

et al. 2023

Spine

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Study Design. Retrospective Case-Control Study. Objectives. The objectives were to determine whether patients from poor social determinants of health, undergoing primary 1- to 2-level lumbar fusion, demonstrate differences in (1) medical complications, (2) emergency department (ED) utilizations, (3) readmission rates, and (4) costs of care. Summary of Background Data. Measures of socioeconomic disadvantage may enable improved targeting and prevention of potentially increased health care utilization. The Area Deprivation Index (ADI) is a validated index of 17 census-based markers of material deprivation and poverty. Materials and Methods. A retrospective query of the 2010-2020 PearlDiver database was performed for primary 1- to 2-level lumbar fusions for degenerative lumbar pathology. High ADI (scale: 0–100) is associated with a greater disadvantage. Patients with high ADI (90%+) were 1:1 propensity score matched to controls (ADI: 0–89%) by age, sex, and Elixhauser Comorbidity Index. This yielded 34,442 patients, evenly matched between cohorts. Primary outcomes were to compare 90-day complications, ED utilizations, readmissions, and costs of care. Multivariable logistic regression models computed the odds ratios (OR) of ADI on complications, ED utilizations, and readmissions. P-values <0.05 were significant. Results. Patients with a high ADI incurred higher rates and odds of developing respiratory failures (1.17% vs. 0.87%; OR: 1.35, P=0.005). Acute kidney injuries (2.61% vs. 2.29%; OR: 1.14, P=0.056), deep venous thromboses (0.19% vs. 0.17%; OR: 1.14, P=0.611), cerebrovascular accidents (1.29% vs. 1.31%; OR: 0.99, P=0.886), and total medical complications (23.35% vs. 22.93%; OR: 1.02, P=0.441) were similar between groups. High ADI patients experienced higher rates and odds of ED visits within 90 days (9.67% vs. 8.91%; OR: 1.10, P=0.014) and overall 90-day expenditures ($54,459 vs. $47,044; P<0.001). Conclusions. Socioeconomically disadvantaged patients have increased rates and odds of respiratory failure within 90 days. ED utilization within 90 days of surgery was higher in socioeconomically disadvantaged patients. Social determinants of health could be used to inform health care policy and improve postdischarge care. Level of Evidence. Level III.

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Impact of Racial and Socioeconomic Disparities on Access to Interspinous Spacer for Treatment of Lumbar Spinal Stenosis: A Nationwide Medicare Analysis

Cho,

Tran,

McGovern

et al. 2024

J. Racial and Ethnic Health Disparities

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Background In mild to moderate lumbar spinal stenosis (LSS) where conservative care treatments fail, minimally invasive treatments, such as interspinous spacers without decompression or fusion (ISD), may be appropriate. While previous studies have demonstrated racial and socioeconomic disparities in the surgical treatment of LSS, there are limited data on how those factors impact accessibility to these procedures. This study explored demographic, socioeconomic, and geographic differences in the use of ISD. Methods Using the Medicare 100% files from 2017 through 2022, this retrospective claims analysis identified when and if patients diagnosed with LSS received ISD implantation. Cox proportional hazards regression was used to examine the association between racial and socioeconomic characteristics and the rate of ISD implantation, stratified by geographic region. Results A total of 1,316,622 individuals met the inclusion criteria; 4730 (0.4%) underwent ISD implantation, with a mean (standard deviation) time to treatment of 11.9 (13.2) months after diagnosis. The likelihood of ISD implantation was higher for older patients (except for the oldest group), males, those with lower disease burden, and White patients. Cox regression revealed that the associations of racial and socioeconomic factors with ISD implantation varied by U.S. region. In the Midwest and Northeast, lower median household income was associated with a decreased likelihood of ISD implantation regardless of race, while in the South, Black patients were less likely to undergo ISD implantation regardless of income. Conclusions The observed disparities in access to ISD implantation mirror existing trends in surgical interventions for LSS, suggesting further study and interventions are needed to address inequities.

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Neighborhood-level socioeconomic status, extended length of stay, and discharge disposition following elective lumbar spine surgery

Cited by 4 publications

References 56 publications

Increased Neighborhood Deprivation Is Associated with Prolonged Hospital Stays After Surgical Fixation of Traumatic Pelvic Ring Injuries

Increased Neighborhood Deprivation Is Associated with Prolonged Hospital Stays After Surgical Fixation of Traumatic Pelvic Ring Injuries

Lower Neighborhood Socioeconomic Status May Influence Medical Complications, Emergency Department Utilization, and Costs of Care After 1-2 Level Lumbar Fusion

Impact of Racial and Socioeconomic Disparities on Access to Interspinous Spacer for Treatment of Lumbar Spinal Stenosis: A Nationwide Medicare Analysis

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