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Published on: February 14, 2025
Effect of Sociodemographic Differences on Elective Lumbar Fusion Surgery
Stevin Lu1, Wyatt Vander Voort, Hania Shahzad
1From the Creighton School of Medicine, Omaha, NE (Mr. Lu); the University of California, Davis, Sacramento, CA (Dr. Vander Voort, Dr. Shahzad, Dr. Saade, Fine, Dr. Ren, Zhao, Dr. Harbison, Dr. Roberto, Dr. Khan, Dr. Le); the University of California, San Francisco, San Francisco, CA (Dr. Booze); and the The University of Texas Health Science Center at Houston, Houston, TX (Dr. Klineberg).
Introduction:
Sociodemographic differences markedly affect postoperative outcomes in lumbar fusion surgery, often leading to higher infection rates, readmissions, emergency department (ED) visits, and prolonged hospital stays. This study examines the associations between sociodemographic factors and clinical outcomes after elective lumbar fusion surgery.
Methods:
We retrospectively analyzed medical records of patients aged ≥18 years who underwent lumbar or lumbosacral fusion for degenerative conditions from 2018 to 2022 at a single academic institution. ED returns and readmissions within 3 months were also recorded. Statistical analysis was conducted using chi-square tests, t-tests, ANOVA, and multivariate logistic regression models.
Results:
A total of 484 patients (54.1% male) were included. Most patients were White (80.4%) and non-Hispanic (91.5%). Men exhibited lower ED utilization (16% versus 23%) and readmission (11.5% versus 19.8%) rates than women. Men were more frequently discharged home (87%) compared with women (79.3%), with fewer discharges to skilled nursing or rehab facilities. No significant differences in length of stay, readmission, ED return, or discharge disposition were observed across racial groups. The private insurance group had shorter hospital stays (3.1 ± 1.7 days) than Medicare/Medicaid patients (3.8 ± 2.6 days) and other groups (4.7 ± 3.3 days, P = 0.005). Medicare/Medicaid patients had higher ED return and readmission rates and were less likely to be discharged home (P < 0.001). Multivariate models revealed that sex and payer status significantly affected readmissions and discharge dispositions.
Conclusion:
Women and Medicare/Medicaid patients experience poorer postoperative outcomes, with increased ED visits and readmissions after lumbar fusion surgery. Race did not significantly affect outcomes, although small sample sizes may have limited this analysis.
