Assistant Professor of Neurosurgery Stanford University School of Medicine Palo Alto, California, United States
Introduction: The influence of socioeconomic status (SES) on postoperative lumbar fusion outcomes is increasingly relevant as rates of lumbar fusion rise. Recent studies suggest SES influences outcomes following spinal fusion; however, past studies are limited by small cohorts from individual hospital systems, states, and catchment areas not easily generalizable and in their focus on few socioeconomic variables. The objective of this study is to determine the influence of SES variables including race, education, net worth, and homeownership on postoperative outcomes following lumbar fusion.
Methods: Optum’s de-identified Clinformatics® Data Mart Database was utilized to conduct a retrospective review of SES variables for patients undergoing first-time, inpatient lumbar fusion from 2003 to 2021. Primary outcomes included hospital length of stay (LOS), and 30-day reoperation, readmission, and post-operative complication rates. Secondary outcomes included post-operative emergency room (ER) visits, discharge status, and total hospital charges.
Results: 217,204 patients were identified. Upon multivariate analysis, Asian, Black, and Hispanic races were associated with increased LOS (Coeff. 0.92, 95% CI 0.68-1.15; Coeff. 0.61, 95% CI 0.51-0.71; Coeff. 0.43, 95% CI 0.32-0.55). Less than 12th grade education (versus greater than a bachelor’s degree) was associated with increased odds of reoperation (OR 1.88, 95% CI 1.03-3.42). Decreased net worth was associated with increased odds of readmission (OR 1.32, 95% CI 1.25-1.40), and complication (OR 1.14, 95% CI 1.10-1.20). Renting a home (versus homeownership) was associated with increased LOS, readmissions, and total charges (Coeff. 0.30, 95% CI 0.17-0.43; OR 1.19, 95% CI 1.11-1.30; Coeff. 13200, 95% CI 9000-17000).
Conclusion : Black race, less than 12th grade education, < $25K net worth, and lack of homeownership were associated with poorer postoperative outcomes and increased costs. Increasing perioperative support for patients with these sociodemographic risk factors may improve postoperative outcomes.
