Combinations of certain social risk factors of race, sex, education, socioeconomic status (SES), insurance, education, employment, and one’s housing situation have been associated with poorer pain and disability outcomes after lumbar spine surgery. To date, an exploration of such factors in patients with cervical spine surgery has not been conducted. The objective of the current work was to 1) define the social risk phenotypes of individuals who have undergone cervical spine surgery for myelopathy and 2) analyze their predictive capacity toward disability, pain, quality of life, and patient satisfaction–based outcomes.
The Cervical Myelopathy Quality Outcomes Database was queried for the period from January 2016 to December 2018. Race/ethnicity, educational attainment, SES, insurance payer, and employment status were modeled into unique social phenotypes using latent class analyses. Proportions of social groups were analyzed for demonstrating a minimal clinically important difference (MCID) of 30% from baseline for disability, neck and arm pain, quality of life, and patient satisfaction at the 3-month and 1-year follow-ups.
A total of 730 individuals who had undergone cervical myelopathy surgery were included in the final cohort. Latent class analysis identified 2 subgroups: 1) high risk (non-White race and ethnicity, lower educational attainment, not working, poor insurance, and predominantly lower SES), n = 268, 36.7% (class 1); and 2) low risk (White, employed with good insurance, and higher education and SES), n = 462, 63.3% (class 2). For both 3-month and 1-year outcomes, the high-risk group (class 1) had decreased odds (all p < 0.05) of attaining an MCID score in disability, neck/arm pain, and health-related quality of life. Being in the low-risk group (class 2) resulted in an increased odds of attaining an MCID score in disability, neck/arm pain, and health-related quality of life. Neither group had increased or decreased odds of being satisfied with surgery.
Although 2 groups underwent similar surgical approaches, the social phenotype involving non-White race/ethnicity, poor insurance, lower SES, and poor employment did not meet MCIDs for a variety of outcome measures. This finding should prompt surgeons to proactively incorporate socially conscience care pathways within healthcare systems, as well as to optimize community-based resources to improve outcomes and personalize care for populations at social risk.
ACDF = anterior cervical discectomy and fusion; ASA = American Society of Anesthesiologists; LCA = latent class analysis; MCID = minimal clinically important difference; mJOA = modified Japanese Orthopaedic Association; NDI = Neck Disability Index; QOD = Quality Outcomes Database; SES = socioeconomic status.
INCLUDE WHEN CITING Published online January 28, 2022; DOI: 10.3171/2021.12.SPINE21874.
Disclosures Dr. Mummaneni is a consultant for Globus, DePuy Synthes, and Stryker; owns stock in Spinicity/ISD; receives royalties from Thieme Publishers, Springer Publishers, and DePuy Synthes; and receives support from AO Spine for non–study-related clinical or research effort. Dr. Bisson is a consultant for Stryker, Medtronic, and MiRus and owns stock in MiRus and nView. Dr. Coric is a consultant for Globus Medical, Medtronic, Spine Wave, Integrity Implants, NuVasive, and Premia Spine. Dr. Foley is a consultant for Medtronic; owns stock in Accelus, Companion Spine, Discgenics, DuraStat, Medtronic, NuVasive, Practical Navigation, RevBio, Spine Wave, Tissue Differentiation Intelligence, Triad Life Sciences, and True Digital Surgery; holds patents with Medtronic and NuVasive; receives royalties from Medtronic; and is on the board of directors of Discgenics, DuraStat, RevBio, TDi, Triad Life Sciences, and True Digital Surgery. Dr. Fu is a consultant for SI Bone, Atlas, Johnson & Johnson, Globus Medical, and Medtronic. Dr. Park is a consultant for Globus Medical and NuVasive, receives royalties from Globus Medical, and receives support from Cerapedics, SI Bone, and DePuy for non–study-related clinical or research effort. Dr. Potts is a consultant for and receives royalties from Medtronic. Dr. C. Shaffrey is a consultant for Medtronic, NuVasive, and SI Bone; receives royalties from Medtronic and NuVasive; owns stock in NuVasive; and receives fellowship support from Globus Medical and NuVasive. Dr. Than is a consultant for Bioventus, DePuy Synthes, and Integrity Implants and serves on the speakers bureaus of Globus Medical and LifeNet Health. Dr. Turner is a consultant for NuVasive, SeaSpine, and ATEC and receives support from NuVasive and SeaSpine for non–study-related clinical or research effort. Dr. Wang is a consultant for DePuy Synthes, Stryker, Medtronic, and Spineology; holds a patent with DePuy Synthes; and owns stock in ISD, Kinesiometrics, and Medical Device Partners.
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