Social determinants of health predict patient reported outcomes 2-years following surgery for Grade 2 spondylolisthesis: A QOD Study

Saturday, May 4, 2024

4:52 PM – 4:57 PM CT

Location: S401ab

Presenting Author(s)

VA

Vardhaan S. Ambati, MS

Medical Student
University of California, San Francisco
San Jose, CA, US

Co-Author(s)

VA

Vardhaan S. Ambati, MS

Medical Student
University of California, San Francisco
San Jose, CA, US
Anthony L. Asher, MD

President AANS, Clinical Professor
Neuroscience Institute, Carolina Neurosurgery & Spine Associates
Charlotte, North Carolina, United States
Erica F. Bisson, MD, MPH

Professor
University of Utah
Salt Lake City, UT, US
Mohamad Bydon, MD, FAANS

Professor of Neurosurgery
Mayo Clinic
Rochester, MN, US
Dean Chou, MD

Chief of the Spine Division, Professor, and Vice Chair of Neurosurgery
Columbia University
New York, New York, United States
Domagoj Coric, MD

Neurosurgeon
Carolina Neurosurgery & Spine Associates
Charlotte, NC, US
Anthony M. DiGiorgio, DO, MHA

Assistant Professor
Department of Neurological Surgery, University of California, San Francisco
San Francisco, California, United States
Kevin T. Foley, MD

Professor
Semmes-Murphey Neurologic and Spine Institute, University of Tennessee
Memphis, TN, US
KF

Kai-Ming Fu, MD, PhD

Associate Professor
Weill Cornell Medical Center
New York, NY, US
Steven D. Glassman, MD (he/him/his)

Medical Director
Norton Leatherman Spine Center
Louisville, KY, US
OG

Oren N. Gottfried, MD

Professor of Neurosurgery
Duke University
Durham, North Carolina, United States
Praveen V. Mummaneni, MD, MBA

Joan O'Reilly Endowed Professor and Vice Chair of Neurosurgery
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US
PP

Paul Park, MD

Professor of Neurosurgery
Semmes-Murphey Neurologic and Spine Institute
MEMPHIS, TN, US
Eric Potts, MD

Neurosurgeon
Goodman Campbell Brain and Spine
Carmel, IN, US
Christopher I. Shaffrey, MD

Professor of Spine Surgery
Duke University Medical Center
Durham, NC, US
MS

Mark Shaffrey, MD

Chair - Department of Neurosurgery
University of Virginia
Charlottesville, VA, US
Jay D. Turner, MD, PhD

Neurosurgery Faculty
Barrow Neurological Institute
Phoenix, AZ, US
Cheerag Upadhyaya, MD, MBA (he/him/his)

Vice Chair of Outpatient Operations, Chief of Business Development and Strategy, Associate Professor of Neurosurgery
University of North Carolina
Chapel Hill, North Carolina, United States
JU

Juan Uribe, MD

Vice Char of Neurosurgery
Barrow Neurological Institute
bogota, Colombia
MV

Michael S. Virk, MD, PhD

Assistant Professor
Weill Cornell Medical Center
New York, New York, United States
Michael Y. Wang, MD

Professor
University of Miami
Miami, FL, US
Timothy J. Yee, MD

Fellow in Neurological Surgery
Department of Neurological Surgery, UCSF
San Francisco, CA, US

Disclosure(s):

Vardhaan S. Ambati, MS: No financial relationships to disclose

Anthony L. Asher, MD: Globus: Royalty Recipient (Ongoing)

Erica F. Bisson, MD, MPH: No financial relationships to disclose

Mohamad Bydon, MD, FAANS: No financial relationships to disclose

Dean Chou, MD: Cerapedics: Grant/Research Support (Ongoing); Cervical Scoliosis Research Society: Grant/Research Support (Ongoing); Globus Medical: Research Grant (Ongoing); Medtronic: Research Grant (Ongoing); Nuvasive: Research Grant (Ongoing); Royal Biologics: Consultant (Ongoing); Spine Committee: Board Member/Officer/Trustee (Ongoing); Spinevision: Consultant (Ongoing); SpineWave: Consultant (Ongoing); Terumo: Consultant (Ongoing)

Domagoj Coric, MD: 3Spine: Stock Shareholder (excluding mutual funds) (Ongoing); Globus Medical: Royalty Recipient (Ongoing); Medtronic: Consultant (Ongoing), Royalty Recipient (Ongoing); Premia Spine: Consultant (Ongoing), Stock Shareholder (excluding mutual funds) (Ongoing); Pressio: Stock Shareholder (excluding mutual funds) (Ongoing); Spine Wave: Consultant (Ongoing), Royalty Recipient (Ongoing), Stock Shareholder (excluding mutual funds) (Ongoing)

Anthony M. DiGiorgio, DO, MHA: AOSpine Foundation: Grant/Research Support (Ongoing); DePuy Synthes Spine: Grant/Research Support (Ongoing)

Kevin T. Foley, MD: Accelus: Stock Shareholder (excluding mutual funds) (Ongoing); Discgenics: Stock Shareholder (excluding mutual funds) (Ongoing); DuraStat: Stock Shareholder (excluding mutual funds) (Ongoing); Medtronic: Consultant (Ongoing), Royalty Recipient (Ongoing), Stock Shareholder (excluding mutual funds) (Ongoing); RevBio: Stock Shareholder (excluding mutual funds) (Ongoing); True Digital Surgery: Stock Shareholder (excluding mutual funds) (Ongoing); Vori Health: Stock Shareholder (excluding mutual funds) (Ongoing)

Kai-Ming Fu, MD, PhD: ATEC: Consultant (Terminated, December 1, 2023); Bioventus: Consultant (Ongoing); DePuy: Consultant (Ongoing)

Steven D. Glassman, MD: No financial relationships to disclose

Praveen V. Mummaneni, MD, MBA: AO Spine: Grant/Research Support (Ongoing); BK Medical: Speaker/Honoraria (Ongoing); Brainlab: Speaker/Honoraria (Ongoing); Depuy Synthes: Consultant (Ongoing); DOD: Research Grant (Ongoing); Globus: Consultant (Ongoing); ISSG: Grant/Research Support (Ongoing); NIH: Research Grant (Ongoing); NREF: Grant/Research Support (Ongoing); Pacira: Grant/Research Support (Ongoing); PCORI: Grant/Research Support (Ongoing); SI Bone: Speaker/Honoraria (Ongoing); SLIP II: Grant/Research Support (Ongoing); Springer Publisher: Royalty Recipient (Ongoing); Thieme Publisher: Royalty Recipient (Ongoing)

Paul Park, MD: Accelus: Consultant (Ongoing); Cerapedics: Grant/Research Support (Terminated, July 15, 2022); Depuy Spine: Consultant (Terminated, July 15, 2022), Grant/Research Support (Terminated, July 15, 2022); Globus Medical: Consultant (Ongoing), Royalty Recipient (Ongoing); ISSG: Grant/Research Support (Ongoing); Medtronic: Consultant (Ongoing); Nuvasive: Consultant (Ongoing); SI Bone: Grant/Research Support (Terminated, July 15, 2022); SMISS: Grant/Research Support (Ongoing)

Eric Potts, MD: Medtronic: Consultant (Ongoing), Royalty Recipient (Ongoing)

Christopher I. Shaffrey, MD: No financial relationships to disclose

Mark Shaffrey, MD: No financial relationships to disclose

Jay D. Turner, MD, PhD: Alphatec: Consultant (Ongoing), Grant/Research Support (Ongoing), Royalty Recipient (Ongoing); Seaspine: Consultant (Ongoing), Royalty Recipient (Ongoing); SI Bone: Consultant (Ongoing), Grant/Research Support (Ongoing), Royalty Recipient (Ongoing)

Cheerag Upadhyaya, MD, MBA: No financial relationships to disclose

Michael Y. Wang, MD: Depuy-Synthes: Consultant (Ongoing), Royalty Recipient (Ongoing); ISD: Stock Shareholder (excluding mutual funds) (Ongoing); Kinesiometrics: Stock Shareholder (excluding mutual funds) (Ongoing); Medical Device Partners: Stock Shareholder (excluding mutual funds) (Ongoing); NuVasive: Consultant (Ongoing); Pacira Pharmaceuticals: Consultant (Ongoing); Spineology: Consultant (Ongoing); Stryker: Consultant (Ongoing)

Timothy J. Yee, MD: No financial relationships to disclose

Introduction: We aim to identify which social determinants of health (SDOH) affect patient reported outcomes (PROs) 2 years after surgery for Meyerding grade 2 spondylolisthesis.

Methods: Patients with grade 2 spondylolisthesis who were prospectively enrolled at the 12-highest enrolling Quality Outcomes Database (QOD) sites were identified. Separate multivariate linear regression models were trained to identify predictors of 2-year postoperative PROs, including numerical rating scale (NRS) leg pain (NRS-LP), back pain (NRS-BP), EQ5D (quality of life), and Oswerty Disability Index (ODI). Each model was trained using the following SDOH: race (white, black, Asian, Native American/Alaskan Native, Native Hawaiian/Pacific islander), insurance payor, ethnicity (Hispanic vs not Hispanic), education level (at least college degree vs no college degree), and preoperative employment status. Each model controlled for age, gender, (American Society of Anesthesiologists) ASA grade, BMI, and preoperative value of the studied PRO.

Results: In total, 400 patients with grade 2 spondylolisthesis. The follow-up rate was 2 years.

Protective SDOH: At least a college degree versus no college degree independently predicted improvements in NRS-LP (β-coefficient:-1.02, p=0.04), NRS-BP (β-coefficient:-0.87,p=0.01), EQ5D (β-coefficient:0.05, p=0.03), and ODI (β-coefficient:-4.2, p< 0.001). Employment preoperatively predicted improvements in NRS-LP (β-coefficient:-0.85, p=0.04) and NRS-BP (β-coefficient:-0.89,p=0.03).

SDOH Risk Factors: Usage of Medicaid versus private insurance was an independent predictor of worse for all PROs, including NRS-LP (β-coefficient:2.5, p=0.006), NRS-BP (β-coefficient:2.2, p=0.02), EQ5D (β-coefficient:-0.14,p=0.02), and ODI (β-coefficient:6.0, p=0.03).

Conclusion : Using multi-variate regression models, many indicators of lower socioeconomic status, such as Medicaid insurance, education level, and employment status were correlated with worse patient reported outcomes after surgery for Grade 2 Spondylolisthesis. These results may help indicate patients for whom more targeted interventions could improve outcomes.