Poster Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

INTRODUCTION:

Social determinants of health (SDoH) are environmental and personal factors that impact healthcare access and outcomes. Patient-reported outcome measures are validated survey instruments that help physicians get a detailed understanding of a patient’s health status. By evaluating the relationships between SDoH and patient-reported outcome measures, we can understand how social factors influence our surgical patients’ health status.

METHODS:

A retrospective review was conducted on a prospectively maintained database.  The cohort included consecutive patients who underwent 1-2-level lumbar decompression and/or fusion at a single institution from 2019-2021. Patients completed PROMIS Anxiety, Depression, Fatigue, Pain Interference (PI), Physical Function (PF), Sleep disturbance (SD), and Social Roles (SR) surveys preoperatively and 12-months postoperatively. Each metric was independently evaluated with ten SDOH factors: age, gender, race, preferred language, ethnicity, work status, community median income, religious belief, insurance status, and marital status. These metrics were also evaluated with four health-related behaviors (HRB): tobacco use, alcohol use, drug use, and physical activity level. Community median income was determined using 2019 American Community Survey data. Physical activity level was measured using metabolic equivalence of task (METS) which was recorded by an anesthesiologist during preoperative intake. Additional metrics including co-morbidities and intraoperative variables were also collected. ANOVA and t-test were used for linear variables, and chi-square test for categorical variables. Univariate and multivariate regression were conducted independently for each patient-reported outcome measure.

RESULTS:

One hundred fifteen patients were included in the study, with mean age 63.9 years, 52.2% female, 80.0% white, 93.9% non-Hispanic, and 41.7% employed. The cohort was 61.7% above the low-income limit, 46.1% privately insured, and 66.1% were married. Thirty-five percent have ever smoked, 17.4% have high-risk alcohol use, and 25.2% have history of drug use. Improvement was seen at 1-year in PROMIS PF, PI, and SR as well as Oswestry Disability Index (ODI). In multivariate analysis, chronic opioid use (COU), depression/anxiety (DA), and per unit decrease in METs were significant predictors for lower preoperative baseline patient-reported outcome measures in ODI [COU:β = 11.5, p=0.002; METs: β = 3.37, p<0.001], PROMIS Anxiety [COU:β = 4.15, p=0.021; DA: β = 5.07, p=0.002; METs: β = 1.45, p=0.011], PROMIS Depression [COU:β = 3.41, p=0.046; DA: β = 6.67, p<0.001], PROMIS Fatigue [COU:β = 5.68, p=0.022; DA: β = 6.53, p=0.003], PROMIS PI [DA: β = 3.13, p=0.036; METs: β = 1.52, p=0.001], and PROMIS PF [COU:β = -2.94, p= 0.039; DA: β = -2.50, p=0.042; METs: β = -0.80, p=0.036]. At one-year follow-up, DA was the most significant predictor of lower patient-reported outcome scores in PROMIS Anxiety [β = 4.51, p=0.022], PROMIS Depression [β = 5.29, p=0.002], PROMIS PI [β = 3.98, p=0.023].

DISCUSSION

Several SDoH and HRB factors predict worse baseline preoperative patient-reported outcome metrics. COU, DA, and METs represent modifiable factors that impact several patient-reported outcome domains. Further work is needed to understand the role of opioid weaning, psychiatry consultation, and physical therapy as part of presurgical optimization.