Higher social vulnerability is associated with lower rates of peripheral nerve decompression surgery

Surgical decompression is often needed to relieve symptoms and prevent long-term disability from compressive peripheral nerve pathologies. This study applied the Social Vulnerability Index (SVI) to characterize utilization patterns in peripheral nerve decompression surgery at a large metropolitan academic medical center.

All adult patients who underwent peripheral nerve decompression between November 2011 and April 2022 were retrospectively identified. Demographic variables, insurance status, and residential ZIP codes were collected. Overall and theme-specific SVI scores were assigned based on patient ZIP Code Tabulation Areas. Procedure rates per 1000 residents were calculated; linear and multivariable regression models assessed associations between procedure rates, overall SVI, and individual SVI themes.

A total of 4844 patients were included (mean age 58.2 ± 15.6 years; 57.5% female; 9.8% Medicaid-insured, ranging from 7.1% in the lowest SVI quartile to 15.8% in the highest; 83.6% White). Higher SVI, reflecting greater community vulnerability, was associated with significantly lower procedure rates per 1000 residents (β = -1.61, p < 0.001). Multivariable analysis indicated that higher vulnerability in Theme 2 (Household Characteristics; β = -1.01, p = 0.0003) and Theme 4 (Housing Type & Transportation; β = -1.14, p = 0.0001) were independently associated with lower procedure rates. Theme 1 (Socioeconomic Status) and Theme 3 (Racial & Ethnic Minority Status) were not significant.

Higher levels of social vulnerability, particularly related to household characteristics and housing/transportation, were independently associated with lower rates of peripheral nerve decompression surgery within our single-institution cohort. These findings highlight differences in utilization of surgical peripheral nerve care related to social vulnerability domains.