Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642 USA.
Medstar Orthopaedic Institute, Georgetown University School of Medicine, 3800 Reservoir Rd NW, Washington DC 20007, USA.
Spine J. 2024 Jan;24(1):107-117. doi: 10.1016/j.spinee.2023.08.016. Epub 2023 Sep 7.
Socioeconomic status (SES) has been associated with differential healthcare outcomes and may be proxied using the area-deprivation index (ADI). Few studies to date have investigated the role of ADI on patient-reported outcomes and clinically meaningful improvement following lumbar spine fusion surgery.
The purpose of this study is to investigate the role of SES on lumbar fusion outcomes using Patient-Reported Outcomes Measurement Information System (PROMIS) surveys.
STUDY DESIGN/SETTING: Retrospective review of a single institution cohort.
About 205 patients who underwent elective one-to-three level posterior lumbar spine fusion.
Change in PROMIS scores and achievement of minimum clinically important difference (MCID).
Patients 18 years or older undergoing elective one-to-three level lumbar spine fusion secondary to spinal degeneration from January 2015 to September 2021 with minimum one year follow-up were reviewed. ADI was calculated using patient-supplied addresses and patients were grouped into quartiles. Higher ADI values represent worse deprivation. Minimum clinically important difference (MCID) thresholds were calculated using distribution-based methods. Analysis of variance testing was used to assess differences within and between the quartile cohorts. Multivariable regression was used to identify features associated with the achievement of MCID.
About 205 patients met inclusion and exclusion criteria. The average age of our cohort was 66±12 years. The average time to final follow-up was 23±8 months (range 12-36 months). No differences were observed between preoperative baseline scores amongst the four quartiles. All ADI cohorts showed significant improvement for pain interference (PI) at final follow-up (p<.05), with patients who had the lowest socioeconomic status having the lowest absolute improvement from preoperative baseline physical function (PF) and PI (p=.01). Only those patients who were in the lowest socioeconomic quartile failed to significantly improve for PF at final follow-up (p=.19). There was a significant negative correlation between socioeconomic level and the absolute proportion of patients reaching MCID for PI (p=.04) and PF (p=.03). However, while ADI was a significant predictor of achieving MCID for PI (p=.02), it was nonsignificant for achieving MCID for PF.
Our study investigated the influence of ADI on postoperative PROMIS scores and identified a negative correlation between ADI quartile and the proportion of patients reaching MCID. Patients in the worse ADI quartile had lower chances of reaching clinically meaningful improvement in PI. Policies focused on alleviating geographical deprivation may augment clinical outcomes following lumbar surgery.
社会经济地位（SES）与医疗保健结果的差异有关，可通过区域剥夺指数（ADI）来间接反映。迄今为止，很少有研究调查 ADI 对腰椎融合手术后患者报告的结果和临床有意义的改善的作用。
本研究旨在使用患者报告的结果测量信息系统（PROMIS）调查研究 SES 对腰椎融合结果的作用。
研究设计/地点：单机构队列的回顾性研究。
约 205 名因脊柱退变接受择期一至三级后路腰椎融合术的患者。
PROMIS 评分变化和达到最小临床重要差异（MCID）。
回顾了 2015 年 1 月至 2021 年 9 月期间因脊柱退变接受一至三级择期腰椎融合术的年龄在 18 岁或以上、至少有 1 年随访的患者。使用患者提供的地址计算 ADI，患者被分为四分位组。较高的 ADI 值表示较差的贫困程度。使用基于分布的方法计算最小临床重要差异（MCID）阈值。方差分析用于评估四分位组内和组间的差异。多变量回归用于确定与达到 MCID 相关的特征。
约 205 名患者符合纳入和排除标准。我们队列的平均年龄为 66±12 岁。平均随访时间为 23±8 个月（范围 12-36 个月）。在四个四分位组之间，术前基线评分之间没有观察到差异。所有 ADI 队列在最终随访时疼痛干扰（PI）均有显著改善（p<.05），社会经济地位最低的患者在术前基线身体功能（PF）和 PI 方面的绝对改善最低（p=.01）。只有社会经济地位最低的四分位组的患者在最终随访时 PF 无显著改善（p=.19）。社会经济水平与 PI（p=.04）和 PF（p=.03）达到 MCID 的患者的绝对比例之间存在显著负相关。然而，虽然 ADI 是 PI 达到 MCID 的显著预测因素（p=.02），但它对 PF 达到 MCID 并不显著。
本研究调查了 ADI 对术后 PROMIS 评分的影响，并确定了 ADI 四分位与达到 MCID 的患者比例之间的负相关。ADI 四分位较差的患者 PI 达到临床意义改善的可能性较低。专注于减轻地域剥夺的政策可能会提高腰椎手术后的临床结果。
