Neighborhood disadvantage predicts health resource utilization after lumbar spine surgery: a cohort study

Socioeconomic factors are increasingly recognized in spine surgery outcomes. Although neighborhood-level deprivation is gaining traction in health outcomes research, its impact in lumbar spine surgery remains inconclusive.

We aimed to evaluate the association between area deprivation index and 90-day unplanned readmissions, reoperations, complications, and length of stay after lumbar spine surgery.

All adult patients who underwent lumbar spine procedures at a single institution between 2011 to 2023 were retrospectively identified using Current Procedural Terminology and International Classification of Diseases 9/10 codes. Geospatial analysis was used to retrieve area deprivation index, with higher indices (> 90) being a high degree of neighborhood socioeconomic disadvantage. Propensity score matching, logistic regressions, univariate comparisons, and log-rank tests were used to assess the association of neighborhood disadvantage with outcomes of interest.

We identified 3568 patients [median age: 64, Interquartile Range (IQR) 56 - 71]. Patients with high neighborhood disadvantage had higher odds of unplanned readmission odds [aOR (adjusted Odds Ratio) 1.77, p = 0.001] and emergency department admission (OR 2.2, p < 0.001) within 30 days. These patients also had higher odds of readmission (aOR 1.72, p < 0.001) and had higher odds of ED readmission odds (OR 2.01, p < 0.001) within 90 days as well. Patients with high neighborhood disadvantage were more likely to have prolonged hospital length of stay (aOR 1.41, p = 0.038) compared to controls. Patients with high neighborhood disadvantage had delayed presentation within 30 days (14.32 vs 10.11 days, p < 0.01) when compared to matched controls. In sub-group analysis, patients who were black, rural, under-insured, and with high comorbidity burden were more sensitive to high neighborhood disadvantage.

Patients with high neighborhood disadvantage have independently increased readmissions and hospital lengths of stay after elective lumbar spine surgery. Neighborhood disadvantage may play a significant role in determining spine surgical outcomes.