Gallagher Ryan S, Karsalia Ritesh, Borja Austin J, Malhotra Emelia G, Punchak Maria A, Na Jianbo, McClintock Scott D, Malhotra Neil R
Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
University of Pennsylvania, Philadelphia, PA, USA.
Global Spine J. 2025 Mar;15(2):1330-1337. doi: 10.1177/21925682241239609. Epub 2024 Mar 21.
Retrospective Matched Cohort Study.
Low median household income (MHI) has been correlated with worsened surgical outcomes, but few studies have rigorously controlled for demographic and medical factors at the patient level. This study isolates the relationship between MHI and surgical outcomes in a lumbar fusion cohort using coarsened exact matching.
Patients undergoing single-level, posterior lumbar fusion at a single institution were consecutively enrolled and retrospectively analyzed (n = 4263). Zip code was cross-referenced to census data to derive MHI. Univariate regression correlated MHI to outcomes. Patients with low MHI were matched to those with high MHI based on demographic and medical factors. Outcomes evaluated included complications, length of stay, discharge disposition, 30- and 90 day readmissions, emergency department (ED) visits, reoperations, and mortality.
By univariate analysis, MHI was significantly associated with 30- and 90 day readmission, ED visits, reoperation, and non-home discharge, but not mortality. After exact matching (n = 270), low-income patients had higher odds of non-home discharge (OR = 2.5, = .016) and higher length of stay (mean 100.2 vs 92.6, = .02). There were no differences in surgical complications, ED visits, readmissions, or reoperations between matched groups.
Low MHI was significantly associated with adverse short-term outcomes from lumbar fusion. A matched analysis controlling for confounding variables uncovered longer lengths of stay and higher rates of discharge to post-acute care (vs home) in lower MHI patients. Socioeconomic disparities affect health beyond access to care, worsen surgical outcomes, and impose costs on healthcare systems. Targeted interventions must be implemented to mitigate these disparities.
回顾性匹配队列研究。
家庭收入中位数（MHI）较低与手术结果恶化相关，但很少有研究在患者层面严格控制人口统计学和医学因素。本研究使用粗化精确匹配法，在腰椎融合队列中分离出MHI与手术结果之间的关系。
连续纳入并回顾性分析在单一机构接受单节段后路腰椎融合术的患者（n = 4263）。通过邮政编码与人口普查数据交叉对照得出MHI。单因素回归分析MHI与手术结果的相关性。根据人口统计学和医学因素，将低MHI患者与高MHI患者进行匹配。评估的结果包括并发症、住院时间、出院处置、30天和90天再入院率、急诊就诊、再次手术和死亡率。
单因素分析显示，MHI与30天和90天再入院率、急诊就诊、再次手术及非家庭出院显著相关，但与死亡率无关。精确匹配后（n = 270），低收入患者非家庭出院的几率更高（OR = 2.5，P = .016），住院时间更长（平均100.2天对92.6天，P = .02）。匹配组之间在手术并发症、急诊就诊、再入院或再次手术方面无差异。
低MHI与腰椎融合术后不良短期结果显著相关。一项控制混杂变量的匹配分析发现，较低MHI患者的住院时间更长，转至急性后期护理机构（而非家中）出院的比例更高。社会经济差异对健康的影响不仅限于获得医疗服务，还会使手术结果恶化，并给医疗系统带来成本。必须实施有针对性的干预措施来减轻这些差异。
