The Effect of Community-Level Socioeconomic Status on Surgical Outcomes Following Revision Lumbar Fusion.

Purpose: The purpose of this study is to determine the impact of community-level socioeconomic status (SES) on surgical outcomes and patient reported outcome measures (PROMs) following revision lumbar fusion.

Methods: Adult patients who underwent revision lumbar fusion surgery from 2011-2021 were grouped by Distressed Community Index (DCI) into Prosperous, Comfortable, Mid-tier, and At risk/Distressed cohorts. Demographics, surgical information, and PROMs were compared based on DCI community status. Outcome measures were collected preoperatively, three months postoperatively, and one year postoperatively.

Results: 853 patients were included in the final cohort. There was no difference in terms of surgical approach or utilization of a staged procedure between the patient groups. Readmission (p=0.752) and reoperation rates (p=0.467) were similar across all community groups. Furthermore, for patients who required reoperation, the incision and drainage or revision surgery rate in each cohort was not statistically different (p=0.902). Prosperous community patients reported significantly lower VAS Back pain preoperatively in comparison to patients from other DCI communities. All groups experienced a similar degree of postoperative improvement in VAS Back scores (p= 0.271). There were no other differences in pre- or postoperative PROMs analyzed.

Conclusions: While there are socioeconomic differences based on DCI, community-level SES was not predictive of worse surgical outcomes following revision lumbar fusion. Patients from the most distressed communities were able to achieve similar improvement after revision surgery. This should encourage spine surgeons to feel comfortable discussing an indicated revision lumbar procedure with patients, and not view SES as a barrier to successful outcomes.