The Role of Social Determinants of Health in 90-day Global Period Utilization after Non-Elective Neurosurgery

Introduction: Post-surgical follow up is important following neurosurgical operations to prevent long-term complications and facilitate recovery. Non-elective surgeries often have lower rates of follow-up compared to the same surgeries performed electively. We sought to identify socioeconomic, demographic, and clinical factors that were associated with reduced utilization of covered services under the 90-day surgical global period following non-elective neurosurgical operations.

Methods: Retrospective analysis identified patients undergoing non-elective neurosurgical operations at our institution with procedures covered under a 90-day global period by the Centers for Medicare & Medicaid Services. Global period utilization was investigated specifically for neurosurgical outpatient follow-up and for any outpatient follow-up. Univariate and multivariable logistic regression analyzed the relationship between global period utilization and clinical, demographic, and socioeconomic factors. A receiver operating characteristic curve established the utility of significant continuous variables in predicting global period utilization.

Results: 1015 patients met inclusion criteria, with 89.4% receiving neurosurgical follow-up and 96.5% receiving any follow-up within the global period. On multivariable analysis, discharge home and shorter post-surgical stay were associated with both increased neurosurgical follow-up and overall follow-up, while lower social vulnerability index transportation score and surgery type were additionally associated with increased overall follow-up. Optimal length of stay cutoffs for predicting follow-up were > 6.5 days for predicting non-utilization of neurosurgical follow-up in the global period and > 10.5 days for predicting non-utilization of any follow-up in the global period.

Conclusion : This study provides guidance on factors impacting follow-up for non-elective neurosurgical operations in order to identify vulnerable patient groups and encourage the development of prospective interventions.