The following is the summary of “Patients From Socioeconomically Distressed Communities Experience Similar Clinical Improvements Following Anterior Cervical Discectomy and Fusion” published in the December 2022 issue of Spine by Lambrechts, et al.
The study was a retrospective cohort. The objective of this study was to evaluate differences in patient-reported outcome measures (PROMs) amongst socioeconomic groups of patients who had undergone anterior cervical discectomy and fusion (ACDF). Race-based comparisons of PROMs were a secondary objective. Although there is some evidence that social determinants of health impact patient outcomes after spine surgery, the literature on the relationship between PROMs and combined socioeconomic status indicators after ACDF needs to be more extensive. From 2014 to 2020, the authors compiled data on patients who had primary elective ACDF performed on anything from one to four levels. Patients were first classified by race and then by which quintile of the Distressed Community Index (DCI) they belonged (White or Black).
DCI group and race were used in a multivariate regression analysis of PROMs, with demographic and surgical covariates held constant. All DCI groups improved on all PROMs, except the Mid-tier group on the mental health component score (MCS-12; P=0.091). At baseline, patients in the Distressed/At-Risk group fared worse on the MCS-12, the visual analog scale (VAS) Neck, and the neck disability index (NDI). The levels of progress made by each DCI group were equivalent. Postoperatively, black patients showed worse MCS-12 (P=0.016), PCS-12 (P=0.03), VAS Neck (P<0.001), VAS Arm (P=0.004), and NDI (P=0.001) than white patients.
On the other hand, being White was an independent predictor of better progress in both the ∆PCS-12 (β=3.09, P=0.036) and the∆ NDI (β=-7.32, P=0.003), although none of the DCI subgroups were found to be significant independent predictors of ∆PROMs. Despite having poorer preoperative PROMs, patients in Distressed areas and Black patients all saw improvements in their clinical conditions. Black patients experienced poorer progress in NDI than White patients, but being from a troubled community did not independently predict worse improvement in any PROMs.