Racial and socioeconomic disparities affect postoperative outcomes for spine surgery patients

Comron Saifi

Racial and socioeconomic disparities in patients’ preoperative physical and mental health at presentation for spine surgery are associated adversely with postoperative outcomes, new research has shown. The results of a retrospective observational study, which sought to examine the racial and socioeconomic factors that drive preoperative disparities in spine surgery patients, were published by Comron Saifi (C. James and Carole Walter Looke chair in orthopedic spine surgery at Houston Methodist Hospital, Houston, USA) and his research team in the journal Spine.

The results mean that a “renewed focus on structural factors influencing preoperative presentation, including timeliness of care, is essential”, say the researchers.

Presenting, postoperative day 90 (POD90), and 12-month outcome scores (PROMIS global physical and mental [GPH, GMH] and Visual Analogue Scale pain [VAS]) were collected for patients undergoing deformity arthrodesis or cervical, thoracic, or lumbar laminotomy or decompression/fusion.

Social determinants of health for a patient’s neighborhood (county, zip code, or census tract) were extracted from public databases. Multivariable linear regression with stepwise selection was used to quantify the association between a patient’s preoperative patient reported outcomes scores (PROs) and sociodemographic variables.

The study found that Black patients presented with one- to three-point higher VAS pain scores (7–8 vs. 5–6) and lower GPH scores (6.5–10 vs. 11–12) than White patients (p<0.05 for all comparisons). Similarly, lower socioeconomic status (SES) patients presented with 1.5 points greater pain (p<0.0001) and 3.5 points lower GPH (p<0.0001) than high SES patients.

Patients with lowest-quartile presenting GPH scores reported 36.8% and 37.5% lower POD-90 GMH and GPH scores than the highest quartile, respectively (GMH: 12 vs. 19, p<0.0001; GPH: 15 vs. 24, p<0.0001). This trend extended to 12 months (GMH: 19.5 vs. 29.5, p<0.0001; GPH: 22 vs. 30, p<0.0001).

Reduced access to primary care (B = −1.616, p<0.0001) and low SES (B = –1.504, p=0.001), proxied by median household value, were independent predictors of worse presenting GPH scores.

Speaking to Spinal News International, Saifi said: “This study clearly demonstrates that racial disparities and social determinants of health have a very real association with a patient’s preoperative and postoperative patient reported clinical outcomes. If we want to continue to improve clinical care, we must address these systemic racial and social health issues.”


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