Low education and low income are “clear independent contributors” to poorer outcomes following lumbar surgery

Emma Karran

Low educational attainment and low income status are clear independent contributors to poorer outcomes following lumbar spine surgery, a new study, published in The Spine Journal by Emma Karran (University of South Australia, Adelaide, Australia) et al, has found.

The study highlighted that, while rates of lumbar back pain continue to rise, poor outcomes following surgical intervention remain common and that further research is needed “to guide best-practice through a health equity lens”.

The aim of this study was to determine the relationships between social determinants of health (SDH) and pain, opioid use, disability and work absenteeism following lumbar spine surgery.

Data was collected from Embase, the Cochrane Library Medline, and Web of Science. Studies which were deemed eligible for inclusion involved participants receiving lumbar spine surgery and investigated the relationship between at least one SDH and post-surgical pain, opioid use, disability or work absenteeism. The research team evaluated the risk of bias of the studies and used the PROGRESS-Plus framework to organise a narrative synthesis of findings.

A total of 23 studies were analysed, involving 30,987 adults from 12 countries. There were 107 relationships between the SDH and post-surgical outcomes which were evaluated; 67 in multivariate analyses.

Education was investigated in 23 analyses (14 studies), and found that 70% revealed significant independent relationships between lower education and poorer outcomes. Socioeconomic status was investigated in nine analyses (four studies), with 67% of participants revealing independent relationships between lower socioeconomic status and poorer outcomes. Gender was investigated in 40 analyses (22 studies), and showed that indications that male versus female sex was associated with poorer outcomes were equivocal.

Speaking to Spinal News International, Karran said: “Our study highlights the importance of considering the broader social contexts of individuals’ lives when making care decisions—particularly when they involve costly and high-risk surgical procedures.

“Optimal management needs to be tailored to the characteristics of those seeking care, and our study indicates a patient’s education status and socioeconomic status are likely to be really important factors to consider. Our review has also revealed that researchers need to strive to form a greater understanding of how the SDH differentially impact patient outcomes to be able to inform more equitable care.”


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