Department of Neurological Surgery, University of Pittsburgh School of Medicine.
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Clin Spine Surg. 2024 Apr 1;37(3):E137-E146. doi: 10.1097/BSD.0000000000001557. Epub 2023 Dec 5.
Retrospective review of a prospectively maintained database.
Assess differences in preoperative status and postoperative outcomes among patients of different educational backgrounds undergoing surgical management of cervical spondylotic myelopathy (CSM).
Patient education level (EL) has been suggested to correlate with health literacy, disease perception, socioeconomic status (SES), and access to health care.
The CSM data set of the Quality Outcomes Database (QOD) was queried for patients undergoing surgical management of CSM. EL was grouped as high school or below, graduate-level, and postgraduate level. The association of EL with baseline disease severity (per patient-reported outcome measures), symptoms >3 or ≤3 months, and 24-month patient-reported outcome measures were evaluated.
Among 1141 patients with CSM, 509 (44.6%) had an EL of high school or below, 471 (41.3%) had a graduate degree, and 161 (14.1%) had obtained postgraduate education. Lower EL was statistically significantly associated with symptom duration of >3 months (odds ratio=1.68), higher arm pain numeric rating scale (NRS) (coefficient=0.5), and higher neck pain NRS (coefficient=0.79). Patients with postgraduate education had statistically significantly lower Neck Disability Index (NDI) scores (coefficient=-7.17), lower arm pain scores (coefficient=-1), and higher quality-adjusted life-years (QALY) scores (coefficient=0.06). Twenty-four months after surgery, patients of lower EL had higher NDI scores, higher pain NRS scores, and lower QALY scores ( P <0.05 in all analyses).
Among patients undergoing surgical management for CSM, those reporting a lower educational level tended to present with longer symptom duration, more disease-inflicted disability and pain, and lower QALY scores. As such, patients of a lower EL are a potentially vulnerable subpopulation, and their health literacy and access to care should be prioritized.
回顾性分析前瞻性维护的数据库。
评估不同教育背景的患者在接受颈椎脊髓病（CSM）手术治疗的术前状态和术后结果方面的差异。
患者教育水平（EL）与健康素养、疾病认知、社会经济地位（SES）和获得医疗保健的机会有关。
在 QOD 脊髓病数据库中查询接受 CSM 手术治疗的患者。EL 分为高中或以下、研究生和研究生以上。评估 EL 与基线疾病严重程度（患者报告的结果测量）、症状 >3 个月或 ≤3 个月以及 24 个月患者报告的结果测量之间的关联。
在 1141 例 CSM 患者中，509 例（44.6%）的 EL 为高中或以下，471 例（41.3%）具有研究生学历，161 例（14.1%）获得研究生以上学历。较低的 EL 与症状持续时间 >3 个月呈统计学显著相关（优势比=1.68）、上肢疼痛数字评分量表（NRS）更高（系数=0.5）和颈部疼痛 NRS 更高（系数=0.79）。具有研究生学历的患者的 Neck Disability Index（NDI）评分（系数=-7.17）、上肢疼痛评分（系数=-1）和更高的质量调整生命年（QALY）评分（系数=0.06）具有统计学显著较低。手术后 24 个月，EL 较低的患者 NDI 评分较高、疼痛 NRS 评分较高、QALY 评分较低（所有分析 P<0.05）。
在接受 CSM 手术治疗的患者中，报告较低教育水平的患者往往表现出更长的症状持续时间、更多的疾病导致的残疾和疼痛，以及较低的 QALY 评分。因此，EL 较低的患者是一个潜在的弱势群体，应优先考虑他们的健康素养和获得医疗保健的机会。
