Sociodemographic Characteristics Predict Readmission Rates After Lumbar Spinal Fusion Surgery

Chen, Stephanie A; White, Robert S.; Tangel, Virginia; Nachamie, Anna S.; Witkin, Lisa R.

doi:10.1093/pm/pny316

Cited by 27 publications

(30 citation statements)

References 48 publications

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“…Previous studies that investigated outcome disparities found that Black patients were more likely to experience higher readmission rates compared with White patients after undergoing certain procedures, such as coronary artery bypass graft surgery or lumbar spinal fusion surgery. 5,6 The factors driving these disparities are believed to vary widely. For instance, a study of women who underwent hysterectomy found that Black women were more likely to be treated by surgeons who performed low volumes of these procedures.…”

Section: Discussionmentioning

confidence: 99%

Hospital Rankings and Health Equity

Binger

Chen

Harder

2022

JAMA

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Section: Discussionmentioning

confidence: 99%

Hospital Rankings and Health Equity

Binger

Chen

Harder

2022

JAMA

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“…Other teams have also described how economic disparities in primary insurance payer, race, and hospital surgical volume affect lumbar spinal fusion readmissions. 11 Since SDH are interdependent and have a complex network of upstream and downstream effects on health, we argue that analyses comparing outcomes in groups experiencing one specific burden fall short of the big picture. Our analysis demonstrates that overall, patients with any type of SDH disparity are at increased risk of developing a complication in the postoperative period, and we argue that further investigation into understanding why and how to prevent outcome disparities is vital.…”

Section: Discussionmentioning

confidence: 99%

Association Between Social Determinants of Health and Postoperative Outcomes in Patients Undergoing Single-Level Lumbar Fusions

Khalid

Maasarani

Nunna

et al. 2020

Spine

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Study Design. Retrospective cohort.Objective. The aim of this study was to analyze association between social determinants of health (SDH) disparity on postoperative complication rates, and 30-day and 90-day allcause readmission in patients undergoing single-level lumbar fusions. Summary of Background Data. Decreasing postoperative complication rates is of great interest to surgeons and healthcare systems. Postoperative complications are associated with poor convalescence, inferior patient reported outcomes measures, and increased health care resource utilization. Better understanding of the association between Social Determinants of Health (SDH) on postoperative outcomes maybe helpful to decrease postoperative complication rates. Methods. MARINER 2020, an all-payer claims database, was utilized to identify patients undergoing single-level lumbar fusions between 2010 and 2018. The primary outcomes were the rates of any postoperative complication, symptomatic pseudarthrosis, need for revision surgery, or 30-day and 90-day allcause readmission. Results. The exact matched population analyzed in this study contained 16,560 patients (8280 [50.0%] patients undergoing single-level lumbar fusion with an SDH disparity; 8280 [50.0%] patients undergoing single-level lumbar fusion without a disparity). Both patient groups were balanced at baseline. The rate of symptomatic pseudarthrosis (1.0% vs. 0.6%, P < 0.05) or any postoperative complication (16.3% vs. 10.4%, P < 0.05) in the matched analysis was higher in the disparity group. The presence of a disparity was associated with 70% increased odds of developing any complication (OR 1.7, 95% CI 1.53-1.84) or symptomatic pseudarthrosis (OR 1.7, 95% CI 1.17 -2.37). Unadjusted and adjusted sensitivity analyses yielded similar results as the primary analysis. Conclusion. Social Determinants of Health affect outcomes in spine surgery patients and are associated with an increased risk of developing postoperative complications following lumbar spine fusion.

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“…known to be associated with musculoskeletal disorders including income and place of residence were not available in the QOD [60,61]. These data are especially important in light of recent work indicating that outcomes following microdiscectomy could not be accurately predicted by commonly captured sociodemographic variables [62].…”

Section: Plos Onementioning

confidence: 99%

Quantifying the collective influence of social determinants of health using conditional and cluster modeling

et al. 2020

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Objectives Our objective was to analyze the collective effect of social determinants of health (SDoH) on lumbar spine surgery outcomes utilizing two different statistical methods of combining variables. Methods This observational study analyzed data from the Quality Outcomes Database, a nationwide United States spine registry. Race/ethnicity, educational attainment, employment status, insurance payer, and gender were predictors of interest. We built two models to assess the collective influence of SDoH on outcomes following lumbar spine surgery—a stepwise model using each number of SDoH conditions present (0 of 5, 1 of 5, 2 of 5, etc) and a clustered subgroup model. Logistic regression analyses adjusted for age, multimorbidity, surgical indication, type of lumbar spine surgery, and surgical approach were performed to identify the odds of failing to demonstrate clinically meaningful improvements in disability, back pain, leg pain, quality of life, and patient satisfaction at 3- and 12-months following lumbar spine surgery. Results Stepwise modeling outperformed individual SDoH when 4 of 5 SDoH were present. Cluster modeling revealed 4 distinct subgroups. Disparities between the younger, minority, lower socioeconomic status and the younger, white, higher socioeconomic status subgroups were substantially wider compared to individual SDoH. Discussion Collective and cluster modeling of SDoH better predicted failure to demonstrate clinically meaningful improvements than individual SDoH in this cohort. Viewing social factors in aggregate rather than individually may offer more precise estimates of the impact of SDoH on outcomes.

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Sociodemographic Characteristics Predict Readmission Rates After Lumbar Spinal Fusion Surgery

Cited by 27 publications

References 48 publications

Hospital Rankings and Health Equity

Hospital Rankings and Health Equity

Association Between Social Determinants of Health and Postoperative Outcomes in Patients Undergoing Single-Level Lumbar Fusions

Quantifying the collective influence of social determinants of health using conditional and cluster modeling

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