Neighborhood Socioeconomic Disadvantage Predicts Extended Length of Stay And Non-Home Discharge but Not Readmissions or Reoperations After Anterior Cervical Discectomy and Fusion.

Abstract

Background context: Socioeconomic disadvantage has been associated with worse outcomes across various surgical disciplines. However, the impact of neighborhood-level disadvantage on outcomes after anterior cervical discectomy and fusion (ACDF) remains poorly studied.

Purpose: To evaluate the association of neighborhood socioeconomic disadvantage, as measured by Area Deprivation Index (ADI), with patient demographics, lengths of stay, discharge dispositions, and 90-day reoperation and readmission rates following ACDF.

Study design/setting: Prospective cohort study of consecutive patients undergoing primary ACDF at a tertiary academic medical center from October 2018 to October 2020.

Patient sample: 395 patients with primary ACDF were included. Patients were assigned ADI scores based on home zip codes and categorized into quartiles: low (≤25), mild (26-50), moderate (51-75), and severe (76-100) disadvantage.

Outcome measures: Length of stay >3 days, non-home discharge, 90-day readmissions, and 90-day reoperations. Demographics, comorbidities, and procedural details were also collected.

Methods: Univariate and multivariate analyses compared outcomes across ADI quartiles. Multivariate logistic regression evaluated the impact of ADI on outcomes while controlling for other factors.

Results: Compared to the low deprivation group, patients with severe deprivation were younger, more likely to be black, unmarried, uninsured, and current smokers (all p<0.001). Higher ADI quartile independently predicted extended length of stay (OR 2.09, 95% CI 1.34-3.41, p<0.001) and non-home discharge (OR 1.83, 95% CI 1.17-3.01, p=0.011). No significant differences were found in 90-day readmissions or reoperations based on ADI.

Conclusions: Greater neighborhood socioeconomic disadvantage is independently associated with prolonged hospitalization and lower likelihood of home discharge after ACDF. These findings highlight the importance of considering social determinants of health in risk stratification and care optimization for patients undergoing spine surgery.