Sun Yifei, Gross Evan G, Hamo Mohammad A, Howell Sasha G, Mooney James, Laskay Nicholas M B, Godzik Jakub
1Heersink School of Medicine and.
2Department of Neurosurgery, University of Alabama at Birmingham, Alabama.
J Neurosurg Spine. 2025 Jan 3;42(3):286-298. doi: 10.3171/2024.8.SPINE24604. Print 2025 Mar 1.
The aim of this study was to evaluate the association of neighborhood-level and individual-level measures of socioeconomic status with readmission, complication rates, and postoperative length of stay of patients with cervical spondylotic myelopathy (CSM) in the Deep South.
The authors identified all patients undergoing surgical intervention for the treatment of CSM from November 2010 to February 2022 using Current Procedural Terminology and ICD-9/ICD-10 codes. Patient demographic, socioeconomic, perioperative, and postoperative data for each patient were collected via review of the electronic medical record. Patient addresses underwent geospatial analysis and were used to extract the Area of Deprivation Index (ADI). Patients with ADIs greater than 75 were considered highly deprived. Univariate comparison and multivariate logistic regressions were used to analyze the relationship between socioeconomic variables and outcomes of interest.
In total, 490 patients with CSM met the inclusion and exclusion criteria. The median age at the time of surgery was 60 (IQR 54-68) years. The median ADI was 75 (IQR 57-90). On multivariate regression analysis, unemployment was found to predict readmission within 1 year of index surgery (OR 4.08, 95% CI 1.87-9.61; p < 0.001). Having high ADI (OR 0.53, 95% CI 0.29-0.94; p = 0.033) and being African American (OR 0.51, 95% CI 0.26-0.97; p = 0.043) were found to be independently protective of readmission. Unemployment was found to be an independent predictor of postoperative complications (OR 3.65, 95% CI 1.52-9.82; p = 0.006). On multivariate regression analysis, high ADI (OR 1.69, 95% CI 1.02-2.81; p = 0.042) and living in a skilled nursing facility/residential facility (OR 8.84, 95% CI 3.08-28.5, p < 0.001) were independent predictors of prolonged length of hospital stay postoperatively.
This is the first single-institution study investigating the influence of neighborhood-level and employment status on readmission, complications, and lengths of stay in patients with CSM in the Deep South. Neighborhood-level measures of socioeconomic status play complex and unique roles in CSM patient outcomes in the Deep South, highlighting the Deep South as a potentially unique geographic region in terms of neurosurgical outcomes. Further research is needed to evaluate methods of alleviating these disparities and improve patient outcomes.
本研究旨在评估美国最南部地区邻里层面和个体层面的社会经济地位指标与脊髓型颈椎病（CSM）患者再入院率、并发症发生率及术后住院时间之间的关联。
作者使用当前手术操作术语和ICD - 9/ICD - 10编码，确定了2010年11月至2022年2月期间所有接受手术治疗CSM的患者。通过查阅电子病历收集每位患者的人口统计学、社会经济、围手术期和术后数据。对患者地址进行地理空间分析，并用于提取贫困指数（ADI）。ADI大于75的患者被认为是高度贫困。采用单因素比较和多因素逻辑回归分析社会经济变量与感兴趣结局之间的关系。
共有490例CSM患者符合纳入和排除标准。手术时的中位年龄为60（四分位间距54 - 68）岁。中位ADI为75（四分位间距57 - 90）。多因素回归分析显示，失业是术后1年内再入院的预测因素（比值比4.08，95%置信区间1.87 - 9.61；p < 0.001）。高ADI（比值比0.53，95%置信区间0.29 - 0.94；p = 0.033）和非裔美国人（比值比0.51，95%置信区间0.26 - 0.97；p = 0.043）被发现对再入院有独立的保护作用。失业被发现是术后并发症的独立预测因素（比值比3.65，95%置信区间1.52 - 9.82；p = 0.006）。多因素回归分析显示，高ADI（比值比1.69，95%置信区间1.02 - 2.81；p = 0.042）和居住在专业护理机构/住宅设施（比值比8.84，95%置信区间3.08 - 28.5，p < 0.001）是术后住院时间延长的独立预测因素。
这是第一项单机构研究，调查了美国最南部地区邻里层面和就业状况对CSM患者再入院、并发症及住院时间的影响。邻里层面的社会经济地位指标在美国最南部地区的CSM患者结局中发挥着复杂而独特的作用，凸显了美国最南部地区在神经外科手术结局方面可能是一个独特的地理区域。需要进一步研究以评估减轻这些差异并改善患者结局的方法。
