The Association of Area Deprivation Index and Spine Surgery Outcomes: A Systematic and Narrative Review.

Abstract

Background and objectives: With an aging population, the prevalence of spine pathology including degenerative spine disease continues to increase. These pathologies present a significant disease burden, often requiring long-term and expensive care. Recent literature has linked several socioeconomic determinants of health with outcomes after spine surgery. We sought to conduct a systematic review to determine the relationship between Area Deprivation Index (ADI), a measure of neighborhood-level socioeconomic status, and objective and patient-reported outcome (PRO) measures after spine surgery and to propose potential interventions.

Methods: An Embase and Medline search was conducted from inception to April 1st, 2024, for relevant articles assessing ADI and spine surgery outcomes. The inclusion criteria were all North American observational studies available in English that reported on the association of ADI and adult cervical, lumbar, neoplastic, or deformity spine surgery outcomes.

Results: Ten articles met the inclusion criteria resulting in a combined 56 925 patients who had undergone elective surgery for cervical, lumbar, spine metastases, and adult spine deformity pathologies. Two studies reported ADI to be associated with increased costs of care and postoperative lengths of stay after cervical spine surgery. Five studies found the association between high ADI with increased rates of respiratory failure, 90-day emergency room visits, longer lengths of stay, 90-day reoperation rates, and poor PROs after lumbar spine surgery. One study found an association with high ADI and increased 30-day and 90-day readmissions across all spine surgeries, and 1 study found no association between ADI and overall survival after surgery for spinal metastases.

Conclusion: Across available literature, high ADI seems to be associated with higher rates of postoperative readmissions and worse PROs. Further studies are needed to better understand the mechanisms underlying the effects of ADI on spine surgery outcomes and identify possible interventions to optimize outcomes.