The Impact of Social Determinants of Health On Postoperative Outcomes in Patients Undergoing Surgical Treatment for Cervical Myelopathy

Wednesday, February 21, 2024

Presenting Author(s)

Hendrick Francois, BS (he/him/his)

Medical Student
University at Buffalo Neurosurgery

Co-Author(s)

Safwan Alomari, n/a

Resident
Johns Hopkins
Baltimore, Maryland, United States
MB

Meghana Bhimreddy, n/a

Medical Student
Johns Hopkins University School of Medicine, United States
AB

Atta Boateng Jr, MHA

Medical Student
Johns Hopkins
Bronx, New York, United States
AB

Ali Bydon, MD

Professor
Johns Hopkins University
Baltimore, Maryland, United States
Daniel Davidar, MD

Research Fellow
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States
Andrew M. Hersh, B.S.

Medical Student
John Hopkins Medical School
Baltimore, MD, US
Kelly Jiang, n/a

Medical Student
Johns Hopkins University School of Medicine
Baltimore, MD, US
Sarah E. Johnson, MBBS

Postdoctoral Research Fellow
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
KS

Kitara Smith, n/a

Medical Student
Johns Hopkins
Silver Spring, Maryland, United States
Nicholas Theodore, MD, MS (he/him/his)

Director, Neurosurgical Spine Center; Professor of Neurosurgery
Johns Hopkins University School of Medicine
Baltimore, MD, US
Carly Weber-Levine, MS (she/her/hers)

Medical Student
Johns Hopkins University School of Medicine
East Setauket, NY, US
TW

Timothy Witham, MD

Professor
Johns Hopkins University
Towson, Maryland, United States

Disclosure(s):

Andrew M. Hersh, AB: No financial relationships to disclose

Sarah E. Johnson, MBBS: No financial relationships to disclose

Carly Weber-Levine, MS: No financial relationships to disclose

Introduction: It is well known that social determinants of health (SDOH) can have a significant impact on a patient’s surgical outcomes. SDOH encompasses a large variety of factors, including education, insurance, hospital distance, and more. Additional studies on the impact of SDOH in spine surgery are needed. Accordingly, this study evaluates the impact of SDOH on postoperative outcomes in patients undergoing surgical treatment for cervical myelopathy.

Methods: A retrospective single-center study identified adult patients that underwent cervical decompression between 2016-2020. Cohort characteristics including age, gender, race, occupation, zip code, insurance, comorbidities, and postoperative complications were collected from patient’s medical charts. T-test, Wilcoxon rank-sum, ANOVA, and Kruskal–Wallis and Chi-squared tests were used to compare continuous and categorical variables, respectively. All statistical analysis was performed in MATLAB.

Results: 500 patients were included in the study with a male predominance of n=302 (60.4%) . The median age was 65 years old, with a range of 18-96 years. Racial demographics included 323 White, 136 Black, 19 Asian, 6 Hispanic, and 16 non-identified patients. Hospital stay was longer in patients with a high school education compared to patients with a college education (mean of 5.24 versus 3.16 days, p=0.007). Case duration was shorter in White patients than in non-White patients (mean of 284.6 versus 308.36 minutes, p=0.039). Patients with public insurance had a longer hospital duration compared to patients with private insurance (median of 4 versus 3 days, p=0.015) and were more likely to be discharged to a rehabilitation center (p < 0.001). Patients with a high school education were also more likely to be discharged to a rehabilitation center when compared to patients with a higher education (p < 0.001).

Conclusion : In conclusion, this study underscores the significant influence of SDOH on surgical outcomes in patients undergoing surgery for cervical myelopathy. Understanding these dynamics is crucial for enhancing surgical care and achieving equitable healthcare outcomes. Further research is warranted to uncover additional SDOH and evaluate their impact on patients.