Examining Relationship between Health Disparities and Pre-Surgical Attitudes with Post-Surgical Outcomes in Patients Undergoing Spine Surgery: Experience of a Single Institution

Introduction: Social determinants of health (SDOH), such as race/ethnicity, education, and healthcare access influence health outcomes. Our comprehensive single institution study aimed to assess the role of SDOH and pre-surgical attitudes on post-surgical outcomes at three, six, nine, and twelve months among patients undergoing spine surgery.

Methods: Institutional review board approval was obtained for a pre-surgical questionnaire exploring SDOH, including area deprivation index (ADI), body mass index (BMI), income, and employment status, as well as pre-surgical attitudes. We prospectively collected electronic medical records data to examine the long-term outcomes of patients. Primary endpoints included morbidity, length of stay (LOS), complications, and patient reported outcomes.

Results: Data on 127 patients was collected at three, six, nine, and twelve months after surgery. The average age was 68.1 years ± 10.9 years and BMI was 30.0 kg/m2 ± 7.36 kg/m2. 115 patients (90.6%) were White and 71 patients (55.9%) were male. Common comorbidities included hypertension in 77 (50.6%) and depression in 37 patients (29.1%). Patients with greater trust had the shortest LOS at 1.69 days ± 1.98 days. There was a negative correlation between area deprivation index (ADI) and familiarity with someone who underwent a spine procedure (p < 0.01). BMI was significantly positively correlated with increased baseline ODI (p < 0.0004). Patients in the lowest income category had higher baseline anxiety at 11.8 ± 3.34 and depression at 11.3 ± 4.23 compared to their wealthier counterparts (p < 0.001). Patients who were unemployed had more frequent ER visits at six-weeks post-op (p < 0.001).

Conclusion : Pre-surgical attitudes, ADI, BMI, income, and employment status were important factors associated with improved surgical outcome measurements, indicating potential focal points for combating health disparities in spinal surgery patients.