Exploring Health Inequalities and Presurgical Attitudes on Postsurgical Outcomes in Spine Surgery

Area of Science:

• Orthopedic Surgery
• Health Disparities Research
• Sociomedical Sciences

Background:

• Social determinants of health (SDOH) significantly influence health disparities.
• The impact of SDOH on postsurgical outcomes in spine surgery is not well-understood at the community level.
• Identifying community-level factors is crucial for addressing health inequities in spinal surgery patients.

Purpose of the Study:

• To explore the relationship between presurgical attitudes, area deprivation index (ADI), income, employment status, and body mass index (BMI).
• To analyze the influence of these factors on postsurgical outcomes at 3, 6, 9, and 12 months after elective spine surgery.
• To identify key factors for improving postsurgical outcomes and reducing health disparities in spine surgery.

Main Methods:

• Prospective analysis of presurgical attitudes.
• Retrospective assessment of area deprivation index (ADI), income, employment status, and body mass index (BMI).
• Inclusion of 127 patients undergoing elective spine surgery between August 2021 and August 2022.
• Univariate analysis of outcomes at 3, 6, 9, and 12 months postsurgery.

Main Results:

• Area deprivation index (ADI) correlated with worse Patient-Reported Outcomes Measurement Information System (PROMIS) and Visual Analog Scale (VAS) scores pre- and postsurgery.
• Lowest income group (<$25,000/year) reported higher PROMIS pain scores one year post-surgery.
• Unemployed patients showed lower social support and healthcare confidence, and higher readmission rates within six weeks.

Conclusions:

• Presurgical attitudes, ADI, income, and employment status are significant factors associated with surgical outcomes.
• These findings highlight potential intervention points for mitigating health disparities in spine surgery.
• Addressing SDOH is critical for improving patient outcomes and achieving health equity in spinal surgery.