• Olivia A Opara, Rajkishen Narayanan, Tariq Issa, Omar H Tarawneh, Yunsoo Lee, Harrison A Patrizio, Abbey Glover, Bergin Brown, Christian McCormick, Mark F Kurd, Ian David Kaye, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, and Gregory D Schroeder.
• Rothman Orthopaedic Institute at Thomas Jefferson University.
• Spine. 2024 Aug 23.

Study DesignRetrospective cohort study.ObjectiveTo examine how community-level economic disadvantage impacts short-term outcomes following posterior cervical decompression and fusion (PCDF) for cervical spondylotic myelopathy.Summary Of Background DataThe effects of socioeconomic factors, measured by the Distress Community Index (DCI), on postoperative outcomes after PCDF are underexplored. By understanding the impact of socioeconomic status (SES) on PCDF outcomes, disparities in care can be addressed.Materials And MethodsRetrospective review of 554 patients who underwent PCDF for cervical spondylotic myelopathy between 2017 and 2022. SES was assessed using DCI obtained from patient zip codes. Patients were stratified into quintiles from Prosperous to Distressed based on DCI. Bivariate analyses and multivariate regressions were performed to evaluate the associations between social determinants of health and surgical outcomes including length of stay, home discharge, complications, and readmissions.ResultsPatients living in At-Risk/Distressed communities were more likely to be Black (53.3%). Patients living in At-Risk/Distressed communities had the longest hospitalization (6.24 d vs. Prosperous: 3.92, P=0.006). Significantly less At-Risk/Distressed patients were discharged home without additional services (37.3% vs. Mid-Tier: 52.5% vs. Comfortable: 53.4% vs. Prosperous: 56.4%, P<0.001). On multivariate analysis, residing in an At-Risk/Distressed community was independently associated with non-home discharge (odds ratio (OR): 2.28, P=0.007) and longer length of stay (E:1.54, P=0.017).ConclusionPatients from socioeconomically disadvantaged communities experience longer hospitalizations and are more likely to be discharged to a rehabilitation or skilled nursing facility following PCDF. Social and economic barriers should be addressed as part of presurgical counseling and planning in elective spine surgery to mitigate these disparities and improve the quality and value of health care delivery, regardless of socioeconomic status.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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