Socioeconomic disadvantage is correlated with worse PROMIS outcomes following lumbar fusion

• Published in: The spine journal 2024-01, Vol.24 (1), p.107-117
• Main Authors: Shaikh, Hashim J.F., Cady-McCrea, Clarke I., Menga, Emmanuel N., Molinari, Robert W., Mesfin, Addisu, Rubery, Paul T., Puvanesarajah, Varun
• Format: Article
• Language: English
• Subjects: ADI; Posterior lumbar fusion; PROMIS; Socioeconomic status
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2023.08.016

Socioeconomic status (SES) has been associated with differential healthcare outcomes and may be proxied using the area-deprivation index (ADI). Few studies to date have investigated the role of ADI on patient-reported outcomes and clinically meaningful improvement following lumbar spine fusion surgery. The purpose of this study is to investigate the role of SES on lumbar fusion outcomes using Patient-Reported Outcomes Measurement Information System (PROMIS) surveys. Retrospective review of a single institution cohort. About 205 patients who underwent elective one-to-three level posterior lumbar spine fusion. Change in PROMIS scores and achievement of minimum clinically important difference (MCID). Patients 18 years or older undergoing elective one-to-three level lumbar spine fusion secondary to spinal degeneration from January 2015 to September 2021 with minimum one year follow-up were reviewed. ADI was calculated using patient-supplied addresses and patients were grouped into quartiles. Higher ADI values represent worse deprivation. Minimum clinically important difference (MCID) thresholds were calculated using distribution-based methods. Analysis of variance testing was used to assess differences within and between the quartile cohorts. Multivariable regression was used to identify features associated with the achievement of MCID. About 205 patients met inclusion and exclusion criteria. The average age of our cohort was 66±12 years. The average time to final follow-up was 23±8 months (range 12–36 months). No differences were observed between preoperative baseline scores amongst the four quartiles. All ADI cohorts showed significant improvement for pain interference (PI) at final follow-up (p