The association of patient education level with outcomes after elective lumbar surgery: a Michigan Spine Surgery Improvement Collaborative study

View More View Less
  • 1 Departments of Neurosurgery and
  • | 2 Public Health Sciences, and
  • | 3 Center for Health Services Research, Henry Ford Hospital, Detroit;
  • | 4 Departments of Orthopedic Surgery and
  • | 5 Neurosurgery, William Beaumont Hospital, Royal Oak;
  • | 6 Departments of Orthopaedic Surgery and
  • | 7 Neurosurgery, University of Michigan Hospital, Ann Arbor;
  • | 8 Department of Orthopedic Surgery, William Beaumont Hospital–Troy, Michigan; and
  • | 9 Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, Illinois
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $376.00
USD  $612.00
Print or Print + Online Sign in

OBJECTIVE

Socioeconomic factors have been shown to impact a host of healthcare-related outcomes. Level of education is a marker of socioeconomic status. This study aimed to investigate the relationship between patient education level and outcomes after elective lumbar surgery and to characterize any education-related disparities.

METHODS

The Michigan Spine Surgery Improvement Collaborative registry was queried for all lumbar spine operations. Primary outcomes included patient satisfaction determined by the North American Spine Society patient satisfaction index, and reaching the minimum clinically important difference of Patient-Reported Outcomes Measurement Information System Physical Function score and return to work up to 2 years after surgery. Multivariate Poisson generalized estimating equation models reported adjusted risk ratios.

RESULTS

A total of 26,229 lumbar spine patients had data available for inclusion in this study. On multivariate generalized estimating equation analysis all comparisons were done versus the high school (HS)/general equivalency development (GED)–level cohort. For North American Spine Society satisfaction scores after surgery the authors observed the following: at 90 days the likelihood of satisfaction significantly decreased by 11% (p < 0.001) among < HS, but increased by 1% (p = 0.52) among college-educated and 3% (p = 0.011) among postcollege-educated cohorts compared to the HS/GED cohort; at 1 year there was a decrease of 9% (p = 0.02) among < HS and increases of 3% (p = 0.02) among college-educated and 9% (p < 0.001) among postcollege-educated patients; and at 2 years, there was an increase of 5% (p = 0.001) among postcollege-educated patients compared to the < HS group. The likelihood of reaching a minimum clinically important difference of Patient-Reported Outcomes Measurement Information System Physical Function score at 90 days increased by 5% (p = 0.005) among college-educated and 9% (p < 0.001) among postcollege-educated cohorts; at 1 year, all comparison cohorts demonstrated significance, with a decrease of 12% (p = 0.007) among < HS, but an increase by 6% (p < 0.001) among college-educated patients and 14% (p < 0.001) among postcollege-educated compared to the HS/GED cohort; at 2 years, there was a significant decrease by 19% (p = 0.003) among the < HS cohort, an increase by 8% (p = 0.001) among the college-educated group, and an increase by 16% (p < 0.001) among the postcollege-educated group. For return to work, a significant increase was demonstrated at 90 days and 1 year when comparing the HS or less group with college or postcollege cohorts.

CONCLUSIONS

This study demonstrated negative associations on all primary outcomes with lower levels of education. This finding suggests a potential disparity linked to education in elective spine surgery.

ABBREVIATIONS

BMI = body mass index; DVT = deep venous thrombosis; GED = general equivalency development; GEE = generalized estimating equation; HS = high school; MCID = minimum clinically important difference; MSSIC = Michigan Spine Surgery Improvement Collaborative; NASS = North American Spine Society; ODI = Oswestry Disability Index; PHQ-2 = Patient Health Questionnaire–2; PRO = patient-reported outcome; PROMIS PF = Patient-Reported Outcomes Measurement Information System Physical Function; RTW = return to work; SES = socioeconomic status.

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $376.00
USD  $612.00
  • 1

    Yanik EL, Kelly MP, Lurie JD, Baldus CR, Shaffrey CI, Schwab FJ, et al. Effect modifiers for patient-reported outcomes in operatively and nonoperatively treated patients with adult symptomatic lumbar scoliosis: a combined analysis of randomized and observational cohorts. J Neurosurg Spine. 2020;33(1):1726.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Olson PR, Lurie JD, Frymoyer J, Walsh T, Zhao W, Morgan TS, et al. Lumbar disc herniation in the Spine Patient Outcomes Research Trial: does educational attainment impact outcome? Spine (Phila Pa 1976).2011;36(26):23242332.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Chapin L, Ward K, Ryken T. Preoperative depression, smoking, and employment status are significant factors in patient satisfaction after lumbar spine surgery. Clin Spine Surg. 2017;30(6):E725E732.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Slover J, Abdu WA, Hanscom B, Weinstein JN. The impact of comorbidities on the change in Short-form 36 and Oswestry scores following lumbar spine surgery. Spine (Phila Pa 1976).2006;31(17):19741980.

    • Search Google Scholar
    • Export Citation
  • 5

    Adogwa O, Parker SL, Shau DN, Mendenhall SK, Bydon A, Cheng JS, et al. Preoperative Zung depression scale predicts patient satisfaction independent of the extent of improvement after revision lumbar surgery. Spine J. 2013;13(5):501506.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    McGirt MJ, Bydon M, Archer KR, Devin CJ, Chotai S, Parker SL, et al. An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: predicting likely individual patient outcomes for shared decision-making. J Neurosurg Spine. 2017;27(4):357369.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Chang V, Schwalb JM, Nerenz DR, Pietrantoni L, Jones S, Jankowski M, et al. The Michigan Spine Surgery Improvement Collaborative: a statewide Collaborative Quality Initiative. Neurosurg Focus. 2015;39(6):E7.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Macki M, Hamilton T, Lim S, Telemi E, Bazydlo M, Nerenz DR, et al. Disparities in outcomes after spine surgery: a Michigan Spine Surgery Improvement Collaborative study. J Neurosurg Spine. 2021;35(1):9199.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Zakaria HM, Mansour T, Telemi E, Xiao S, Bazydlo M, Schultz L, et al. Patient demographic and surgical factors that affect completion of patient-reported outcomes 90 days and 1 year after spine surgery: analysis from the Michigan Spine Surgery Improvement Collaborative (MSSIC). World Neurosurg. 2019;130:e259e271.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Macki M, Alvi MA, Kerezoudis P, Xiao S, Schultz L, Bazydlo M, et al. Predictors of patient dissatisfaction at 1 and 2 years after lumbar surgery. J Neurosurg Spine. 2020;32(3):373382.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Zakaria HM, Mansour TR, Telemi E, Asmaro K, Macki M, Bazydlo M, et al. Use of Patient Health Questionnaire-2 scoring to predict patient satisfaction and return to work up to 1 year after lumbar fusion: a 2-year analysis from the Michigan Spine Surgery Improvement Collaborative. J Neurosurg Spine. 2019;31(6):794801.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Dionne CE, Von Korff M, Koepsell TD, Deyo RA, Barlow WE, Checkoway H. Formal education and back pain: a review. J Epidemiol Community Health. 2001;55(7):455468.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Laaksonen M, Talala K, Martelin T, Rahkonen O, Roos E, Helakorpi S, et al. Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: a follow-up of 60 000 men and women over 23 years. Eur J Public Health. 2008;18(1):3843.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Walid MS, Robinson ECM, Robinson JS Jr. Higher comorbidity rates in unemployed patients may significantly impact the cost of spine surgery. J Clin Neurosci. 2011;18(5):640644.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Adogwa O, Elsamadicy AA, Han JL, Cheng J, Karikari I, Bagley CA. Do measures of surgical effectiveness at 1 year after lumbar spine surgery accurately predict 2-year outcomes? J Neurosurg Spine. 2016;25(6):689696.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Khan I, Bydon M, Archer KR, Sivaganesan A, Asher AM, Alvi MA, et al. Impact of occupational characteristics on return to work for employed patients after elective lumbar spine surgery. Spine J. 2019;19(12):19691976.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Asher AL, Devin CJ, Archer KR, Chotai S, Parker SL, Bydon M, et al. An analysis from the Quality Outcomes Database, Part 2. Predictive model for return to work after elective surgery for lumbar degenerative disease. J Neurosurg Spine. 2017;27(4):370381.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    DiGiorgio AM, Mummaneni PV, Park P, Chan AK, Bisson EF, Bydon M, et al. Correlation of return to work with patient satisfaction after surgery for lumbar spondylolisthesis: an analysis of the Quality Outcomes Database. Neurosurg Focus. 2020;48(5):E5.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Chotai S, Sivaganesan A, Parker SL, McGirt MJ, Devin CJ. Patient-specific factors associated with dissatisfaction after elective surgery for degenerative spine diseases. Neurosurgery. 2015;77(2):157163.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1695 1695 348
Full Text Views 135 135 79
PDF Downloads 203 203 124
EPUB Downloads 0 0 0