Assessing the Role of Presurgical Attitudes in the Progression of Long-Term Spinal Surgery Outcomes

Introduction: While it has been established that social determinants of health (SDOH) affect patient reported outcomes, there is limited research investigating the role of SDOH in spine surgery. This study aims to describe the role of the SDOH in elective spinal surgery through the evaluation of pre-surgical attitudes' and support systems' role in overall surgical outcomes.

Methods: From August 2021 to August 2022, spinal surgery patients from a single, large, academic institution completed a pre-operative survey rating affordability, trust in healthcare, attitude regarding spine surgery, and social support. Over one-year postoperatively, data analysis evaluating the association between pre-surgical attitudes and postoperative outcomes was performed using descriptive and regression analysis.

Results: 127 patients, ages 68.1±10.9 years, including 71 males (55.9%) were analyzed. Six patients (4.72%) had high financial strain compared to 80 patients (63.0%) indicating low. Additionally, 84 patients (66.1%) indicated a high trust in healthcare, 101 patients (79.5%) reported strong social support, and 87 patients (68.5%) had a positive attitude regarding surgery. Patients reporting financial strain due to surgery had a significantly higher Oswestry Disability Index (ODI) at 12 months postoperatively (slope:-6.88, 95% CI:(-12.61,-1.14), p=0.0286), while no difference was observed at baseline ODI (slope:-2.09, 95% CI:(-4.31,0.12), p=0.0664). Similarly, as patient trust in the healthcare system increased, the 12-month ODI was significantly lower (slope:12.74, 95% CI:(4.67,20.82), p=0.0055). Patients with a more positive attitude towards surgery had a larger improvement in Visual Analogue Scale (VAS) leg (slope:2.09, 95% CI:(0.13,4.05), p=0.0483) and PROMIS pain interference (slope:4.27, 95% CI:(0.96,7.57), p=0.0181) from baseline to 12-months postoperative. Limited social support was associated with an additional spinal surgery within one year (OR:1.88, 95% CI:(1.10,3.20), p=0.0212).

Conclusion : This study’s findings highlight the importance of preoperative patient perspective and resources on surgical outcomes, necessitating further action to combat disparities in SDOH for improvement of overall patient care.