The Impact of Social Determinants of Health on the Severity of Symptoms at Presentation and Discharge Disposition in Patients Undergoing Surgical Treatment of Cervical Myelopathy.
Hendrick Francois, Atta Boateng, Carly Weber-Levine, Kelly Jiang, Smruti Mahapatra, A Daniel Davidar, Andrew M Hersh, Safwan Alomari, Sarah Johnson, Meghana Bhimreddy, Kitara Smith, Tej D Azad, Kimberly Ashayeri, Nicholas Theodore
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引用次数: 0
Abstract
Background and objectives: Social determinants of health (SDOH), such as education, insurance, race, and income, significantly affect a patient's medical care and surgical outcomes. Additional studies characterizing the impact of SDOH on patients undergoing spine surgery are needed. Accordingly, this study evaluates the impact of SDOH on severity of symptoms at presentation and discharge disposition in patients undergoing surgical treatment of cervical myelopathy.
Methods: A retrospective single-center study identified adult patients undergoing surgical intervention for cervical myelopathy between 2016 and 2020. Cohort characteristics were collected from patient medical records. The t-test, Wilcoxon rank-sum, analysis of variance, Kruskal-Wallis, and χ2 tests were used to compare variables when appropriate. Multivariable linear and logistic regression analyses were conducted for modified Japanese Orthopaedic Association (mJOA) and discharge disposition. All statistical analysis was performed in MATLAB R2022b (MathWorks, Natick, MA).
Results: A total of 480 patients were included in the study with a male predominance of n = 281 (59%) and a mean age of 62 ± 13 years. Racial demographics included 64% White (n = 308) and 36% Non-White (n = 172) patients. On univariable analysis, mJOA at presentation was significantly associated with employment status (P < .01), annual income (P < .01), education level (P < .01), and insurance status (P = .03). On multivariable analysis, annual income and education level continued to be significant predictors of presenting mJOA. On univariable analysis, discharge disposition was associated with body mass index (P = .01), mJOA at presentation (P < .01), employment status (P = .05), annual income (P < .01), education level (P < .01), insurance (P < .01), approach (P < .01), and length of stay (P < .01). On multivariable analysis, mJOA at presentation, education level, insurance, and approach continued to be significant predictors of discharge disposition.
Conclusion: SDOH affect the severity of symptoms at presentation and discharge disposition in patients undergoing surgery for cervical myelopathy. Understanding these dynamics and uncovering additional SDOH are critical for enhancing surgical care and achieving equitable healthcare outcomes.
期刊介绍：
Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery.
Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.
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