Neighborhood Disadvantage Predicts Perioperative Outcomes and Long-term Survival Following Spine Tumor Surgery: A 7-year Single-institution Analysis

Introduction: Social determinants of health (SDoH) have been demonstrated to predict postoperative outcomes for neurosurgical oncology. However, these trends are less characterized for spine tumors, relative to intracranial tumors.

Methods: We analyzed all patients undergoing spine tumor surgery at Rhode Island Hospital from 2015-2022. Neighborhood disadvantage was quantified with the Area Deprivation Index (ADI), a validated metric that composites seventeen SDoH variables and ranges continuously from 0% (higher advantage) to 100% (higher disadvantage). Patient addresses were matched to ADI for their Census block of residence. Subsequently, the study population was dichotomized into advantaged (ADI=0-33%) and disadvantaged (ADI=34-100%) cohorts. Multivariable logistic, gamma log-link, and Cox regression adjusted for fourteen confounders, including tumor type (primary-extradural, primary-intradural, secondary [all metastatic pathologies]), age, sex, race, insurance, comorbidities, presenting severity, and surgical case complexity.

Results: 237 patients underwent spine tumor surgery from 2015-2022, with an average age of 53.9 years. 56.9% had primary tumors, whereas 43.1% had secondary tumors. 55.3% (n=131) were classified by ADI into the disadvantaged cohort. This cohort had higher rates of ambulation deficits on presentation (39.2% vs. 21.7%, P=0.017). Postoperatively, disadvantaged patients exhibited higher odds of residual tumor (odds ratio [OR]=2.55, P=0.040), especially for secondary tumors (OR=5.85, P=0.047), but no differences in disposition, length of stay, or complications. Postoperative survival was 75.1% (mean follow-up=18 months), with the disadvantaged cohort experiencing significantly shorter survival (hazard ratio [HR]=2.10, P=0.044). This population additionally had higher odds of poor functional status on follow-up (OR=2.01, P=0.012), as quantified by ECOG Performance Status. Finally, for primary tumors, disadvantaged patients experienced significantly elevated readmission (OR=3.53, P=0.031) and reoperation (OR=2.15, P=0.005) rates.

Conclusion : Neighborhood disadvantage predicts higher presenting severity, shorter postoperative survival, poorer functional status, and elevated readmissions and reoperations following spine tumor surgery. The ADI may be used to risk stratify spine oncology patients and guide targeted interventions to ameliorate neurosurgical disparities.