Socioeconomic disadvantage is correlated with worse PROMIS outcomes following lumbar fusion.

ADI PROMIS Posterior lumbar fusion Socioeconomic status

Journal

The spine journal : official journal of the North American Spine Society
ISSN: 1878-1632
Titre abrégé: Spine J
Pays: United States
ID NLM: 101130732

Informations de publication

Date de publication:
07 Sep 2023
Historique:
received: 22 01 2023
revised: 16 08 2023
accepted: 29 08 2023
pubmed: 9 9 2023
medline: 9 9 2023
entrez: 8 9 2023
Statut: aheadofprint

Résumé

Socioeconomic status (SES) has been associated with differential healthcare outcomes and may be proxied using the area-deprivation index (ADI). Few studies to date have investigated the role of ADI on patient-reported outcomes and clinically meaningful improvement following lumbar spine fusion surgery. The purpose of this study is to investigate the role of SES on lumbar fusion outcomes using Patient-Reported Outcomes Measurement Information System (PROMIS) surveys. Retrospective review of a single institution cohort. About 205 patients who underwent elective one-to-three level posterior lumbar spine fusion. Change in PROMIS scores and achievement of minimum clinically important difference (MCID). Patients 18 years or older undergoing elective one-to-three level lumbar spine fusion secondary to spinal degeneration from January 2015 to September 2021 with minimum one year follow-up were reviewed. ADI was calculated using patient-supplied addresses and patients were grouped into quartiles. Higher ADI values represent worse deprivation. Minimum clinically important difference (MCID) thresholds were calculated using distribution-based methods. Analysis of variance testing was used to assess differences within and between the quartile cohorts. Multivariable regression was used to identify features associated with the achievement of MCID. About 205 patients met inclusion and exclusion criteria. The average age of our cohort was 66±12 years. The average time to final follow-up was 23±8 months (range 12-36 months). No differences were observed between preoperative baseline scores amongst the four quartiles. All ADI cohorts showed significant improvement for pain interference (PI) at final follow-up (p<.05), with patients who had the lowest socioeconomic status having the lowest absolute improvement from preoperative baseline physical function (PF) and PI (p=.01). Only those patients who were in the lowest socioeconomic quartile failed to significantly improve for PF at final follow-up (p=.19). There was a significant negative correlation between socioeconomic level and the absolute proportion of patients reaching MCID for PI (p=.04) and PF (p=.03). However, while ADI was a significant predictor of achieving MCID for PI (p=.02), it was nonsignificant for achieving MCID for PF. Our study investigated the influence of ADI on postoperative PROMIS scores and identified a negative correlation between ADI quartile and the proportion of patients reaching MCID. Patients in the worse ADI quartile had lower chances of reaching clinically meaningful improvement in PI. Policies focused on alleviating geographical deprivation may augment clinical outcomes following lumbar surgery.

Sections du résumé

BACKGROUND CONTEXT BACKGROUND
Socioeconomic status (SES) has been associated with differential healthcare outcomes and may be proxied using the area-deprivation index (ADI). Few studies to date have investigated the role of ADI on patient-reported outcomes and clinically meaningful improvement following lumbar spine fusion surgery.
PURPOSE OBJECTIVE
The purpose of this study is to investigate the role of SES on lumbar fusion outcomes using Patient-Reported Outcomes Measurement Information System (PROMIS) surveys.
STUDY DESIGN/SETTING METHODS
Retrospective review of a single institution cohort.
PATIENT SAMPLE METHODS
About 205 patients who underwent elective one-to-three level posterior lumbar spine fusion.
OUTCOME MEASURES METHODS
Change in PROMIS scores and achievement of minimum clinically important difference (MCID).
METHODS METHODS
Patients 18 years or older undergoing elective one-to-three level lumbar spine fusion secondary to spinal degeneration from January 2015 to September 2021 with minimum one year follow-up were reviewed. ADI was calculated using patient-supplied addresses and patients were grouped into quartiles. Higher ADI values represent worse deprivation. Minimum clinically important difference (MCID) thresholds were calculated using distribution-based methods. Analysis of variance testing was used to assess differences within and between the quartile cohorts. Multivariable regression was used to identify features associated with the achievement of MCID.
RESULTS RESULTS
About 205 patients met inclusion and exclusion criteria. The average age of our cohort was 66±12 years. The average time to final follow-up was 23±8 months (range 12-36 months). No differences were observed between preoperative baseline scores amongst the four quartiles. All ADI cohorts showed significant improvement for pain interference (PI) at final follow-up (p<.05), with patients who had the lowest socioeconomic status having the lowest absolute improvement from preoperative baseline physical function (PF) and PI (p=.01). Only those patients who were in the lowest socioeconomic quartile failed to significantly improve for PF at final follow-up (p=.19). There was a significant negative correlation between socioeconomic level and the absolute proportion of patients reaching MCID for PI (p=.04) and PF (p=.03). However, while ADI was a significant predictor of achieving MCID for PI (p=.02), it was nonsignificant for achieving MCID for PF.
CONCLUSIONS CONCLUSIONS
Our study investigated the influence of ADI on postoperative PROMIS scores and identified a negative correlation between ADI quartile and the proportion of patients reaching MCID. Patients in the worse ADI quartile had lower chances of reaching clinically meaningful improvement in PI. Policies focused on alleviating geographical deprivation may augment clinical outcomes following lumbar surgery.

Identifiants

DOI: 10.1016/j.spinee.2023.08.016 PMID: 37683769
pubmed: 37683769
pii: S1529-9430(23)03369-7
doi: 10.1016/j.spinee.2023.08.016
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 Elsevier Inc. All rights reserved.

Auteurs

Hashim J F Shaikh (HJF)

Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642 USA.

Clarke I Cady-McCrea (CI)

Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642 USA.

Emmanuel N Menga (EN)

Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642 USA.

Robert W Molinari (RW)

Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642 USA.

Addisu Mesfin (A)

Medstar Orthopaedic Institute, Georgetown University School of Medicine, 3800 Reservoir Rd NW, Washington DC 20007, USA.

Paul T Rubery (PT)

Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642 USA.

Varun Puvanesarajah (V)

Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642 USA. Electronic address: vpuvanesarajah@gmail.com.

Classifications MeSH