(SS#II) Impact of Educational Background on Preoperative Disease Severity and Postoperative Outcomes Among Patients with Lumbar Spondylolisthesis: A Quality Outcomes Database (QOD) Study

Introduction: Patient education has been correlated with increased disease-related morbidity and decreased access to care. However, the associations between educational level, preoperative disease severity, and postoperative outcomes in patients with lumbar spondylolisthesis have yet to be explored.

Methods: The spondylolisthesis dataset of the Quality Outcomes Database (QOD) – a cohort with prospectively collected data and up to five years of follow-up – was utilized and stratified for educational level. Patients were classified into three categories based on their level of education (i.e., high school or below, graduate, postgraduate). Patient-reported outcome measures (PROMs) documented at baseline and follow-up included the Oswestry Disability Index (ODI), EuroQol-5D (EQ-5D) in quality-adjusted life years (QALY), and the Numerical Rating Scale (NRS) for back and leg pain. The PROMs ascertained equated to disease severity. Postoperatively, patients also completed the North American Spine Society 1-2 (NASS 1-2) to measure their satisfaction with surgery. Multivariable regression analysis was used to compare education level with disease severity.

Results: Six hundred and eight patients were included for analysis, of which 260 (42.8%) patients had an educational level of high school or below. Patients with a lower educational level were of lower socioeconomic status and were more likely to present with both back and leg pain. Educational level correlated negatively with baseline disease severity as indicated by ODI, EQ-5D (in QALY), NRS leg and back pain scores. Educational level was an independent predictor of worse ODI (coefficient = 3.72, p = 0.046) and back pain NRS (coefficient = 0.51, p = 0.039) scores at baseline. Five years after surgery, patients of different educational backgrounds had similar rates of minimal clinically important difference in PROMs, but discrepancies between different educational levels were prevalent in final PROMs.

Conclusion : Lower patient education level is associated with a greater baseline disease severity in patients with lumbar spondylolisthesis. Patients benefit from surgery equally across different educational backgrounds, yet patients of high school or below educational level have worse long-term outcomes due to their greater disease severity at baseline.