Social Determinants of Health Influence Early Outcomes Following Lumbar Spine Surgery

Samuel E. Holbert; Kristina Andersen; Deborah Stone; Karen Pipkin; Justin Turcotte; Chad Patton

doi:10.31486/toj.22.0066

Article Figures & Data

Tables

View popup

Table 1.

Summary of Patient Demographics, Surgeries, and Outcomes

Variable	All Patients, n=951
Age, years, mean ± SD	61.2 ± 14.2
American Society of Anesthesiologists physical status classification ≥3	413 (43.4)
Non-White race^a	117 (12.7)
Above the Maryland median household income^b	161 (17.4)
Surgery performed
Decompressive laminectomy without fusion	484 (50.9)
Decompressive laminectomy with instrumented posterolateral fusion	467 (49.1)
Outcomes
Length of stay, hours, mean ± SD	46.7 ± 47.0
Discharge to skilled nursing facility	57 (6.0)
30-day emergency department return	65 (6.8)
30-day readmission	28 (2.9)

↵^aTwenty-seven patients chose not to disclose race and are not included.
↵^bTwenty-seven out-of-state patients are not included in the household income analysis.
Note: Data are presented as n (%) unless otherwise indicated.

View popup

Table 2.

Prevalence of Social Determinants of Health

Social Determinant	Patient Responses, n	Prevalence, n (%)
Exercises 3 or more times per week	280	122 (43.6)
High levels of stress	306	22 (7.2)
Attends church	253	137 (54.2)
Currently married or has a life partner	283	211 (74.6)
Experienced spousal abuse (physical, emotional, or sexual)	273	9 (3.3)
Financial strain (somewhat hard or worse)	294	58 (19.7)
Above high school education	225	163 (72.4)
Has any food worry	292	35 (12.0)
Has any transportation problem	295	9 (3.1)
Drinks alcohol 4 or more days per week	816	129 (15.8)

View popup

Table 3.

Social Determinants of Health by Race and Household Income

	Race			Household Income
Social Determinant	White Race	Non-White Race	P Value	Below Median	Above Median	P Value
Exercises 3 or more times per week	109/249 (43.8)	13/31 (41.9)	0.846	108/227 (47.6)	14/48 (29.2)	0.020
High levels of stress	16/268 (6.0)	5/38 (13.2)	0.158^a	20/249 (8.0)	2/50 (4.0)	0.551^a
Attends church	115/223 (51.6)	22/30 (73.3)	0.025	119/213 (55.9)	15/37 (40.5)	0.084
Currently married or has a life partner	190/250 (76.0)	21/33 (63.6)	0.125	169/231 (73.2)	35/47 (74.5)	0.853
Experienced spousal abuse (physical, emotional, or sexual)	7/243 (2.9)	2/30 (6.7)	0.259^a	8/223 (3.6)	1/45 (2.2)	1.000^a
Financial strain (somewhat hard or worse)	47/256 (18.4)	11/38 (28.9)	0.126	50/239 (20.9)	8/49 (16.3)	0.465
Above high school education	145/200 (72.5)	18/25 (72.0)	0.958	133/182 (73.1)	27/39 (69.2)	0.626
Has any food worry	25/256 (9.8)	9/36 (25.0)	0.022^a	31/237 (13.1)	4/48 (8.3)	0.361
Has any transportation problem	6/258 (2.3)	3/37 (8.1)	0.090^a	8/240 (3.3)	1/49 (2.0)	1.000^a
Drinks alcohol 4 or more days per week	122/719 (17.0)	7/97 (7.2)	0.013	117/668 (17.5)	10/149 (6.7)	0.001

↵^aFisher exact test. Fisher exact test was performed when >20% of cells had an expected count <5. Chi-square test was performed in analyses without superscript notation.
Notes: Data are presented as number of patients with the social determinant of health/number of eligible respondents (eg, patients responding to the social determinant of health question and with race or household income data available). Statistically significant values are shown in bold.

View popup

Table 4.

Multivariate Linear and Logistic Regression of Outcomes by Household Income Status and Social Determinants of Health After Controlling for Age, American Society of Anesthesiologists Classification, and Surgery Type

Household Income Status/Social Determinant	LOS, Hours, β	Discharge to SNF, Odds Ratio	30-Day ED Return, Odds Ratio	30-Day Readmission, Odds Ratio
Above the Maryland median household income	–3.6 (P=0.313)	2.216 (P=0.018)	0.576 (P=0.180)	0.364 (P=0.174)
Exercises 3 or more times per week	–8.1 (P=0.105)	0.218 (P=0.058)	1.277 (P=0.631)	1.118 (P=0.871)
High levels of stress	4.3 (P=0.653)	0.000 (P=0.998)	0.000 (P=0.998)	3.004 (P=0.217)
Attends church	5.9 (P=0.261)	0.776 (P=0.675)	0.250 (P=0.021)	1.402 (P=0.602)
Currently married or has a life partner	–23.4 (P<0.001)	0.183 (P=0.005)	0.908 (P=0.859)	0.701 (P=0.573)
Experienced spousal abuse (physical, emotional, or sexual)	–10.2 (P=0.452)	0.000 (P=0.999)	0.000 (P=0.999)	0.000 (P=0.999)
Financial strain (somewhat hard or worse)	14.3 (P=0.022)	0.000 (P=0.997)	2.285 (P=0.133)	0.754 (P=0.732)
Above high school education	–6.5 (P=0.297)	0.834 (P=0.783)	0.566 (P=0.357)	>100 (P=0.997)
Has any food worry	0.7 (P=0.927)	0.858 (P=0.889)	1.558 (P=0.513)	0.000 (P=0.998)
Has any transportation problem	21.1 (P=0.135)	5.820 (P=0.140)	2.338 (P=0.450)	3.469 (P=0.281)
Drinks alcohol 4 or more days per week	–1.5 (P=0.704)	0.498 (P=0.138)	0.635 (P=0.316)	0.656 (P=0.509)

Note: Statistically significant values are shown in bold.
ED, emergency department; LOS, length of stay; SNF, skilled nursing facility.