Association Between Median Household Income and Outcomes of Lumbar Spinal Fusion: an analysis of the National Inpatient Sample (2009-2020)

Saturday, May 4, 2024

4:21 PM – 4:23 PM CT

Location: S403ab

Presenting Author(s)

John Pollina, MD

Vice Chairman Director of Spine Surgery Director of Fellowship, Spine Surgery Associate Professor
University at Buffalo Neurosurgery
Williamsville, New York, United States
Mohamed AR Soliman, MD

Neurosurgeon
University of Buffalo
Buffalo, NY, US

Co-Author(s)

Ahmed Elbayomy, MD (he/him/his)

Postdoctoral Research Fellow
Department of Neurological surgery, University of Wisconsin Madison
AK

Ali Khan, BS

Medical Student
University at Buffalo Neurosurgery, United States
AK

Asham Khan, MD

Neurosurgery Resident
University at Buffalo Neurosurgery, United States
Jeffrey Mullin, MD

Assistant Professor
University of Buffalo
Buffalo, NY, US
Esteban Quiceno Restrepo, MD

Spine fellow
University at Buffalo Neurosurgery
Buffalo, NY, US

Disclosure(s):

John Pollina, MD: No financial relationships to disclose

Esteban Quiceno Restrepo, MD: No financial relationships to disclose

Mohamed AR Soliman, MD: No financial relationships to disclose

Introduction: The relationship between low socioeconomic status and healthcare outcomes has been well established within certain particular surgical procedures. There is however scarcity of literature focused on the relationship between median household income and postoperative outcomes after lumbar spinal fusion.

Methods: The National Inpatient Sample (NIS) database was employed to identify all patients who underwent spinal fusion procedures between 2009 and 2020. Patients were categorized into quartiles based on the median household income of their respective zip codes. We employed both univariate and multivariate linear/logistic regression models to analyze the data.

Results: A total of 2,826,396 patients were included in the study. Patients in the lower income quartile compared to the highest income quartile exhibited elevated rates of risk factors, including congestive heart failure (3.26% vs 2.59%; p< 0.001), chronic pulmonary disease (18.54% vs 14.39%; p< 0.001), diabetes mellitus (17.47% vs 12.45%; p< 0.001), hypertension (57.30% vs 51.86%; p< 0.001), and obesity (18.83% vs 16.50%; p< 0.001).

In the multivariate regression analysis post-operative neurological injuries were less common in the 4th quartile compared to the 1st quartile 0.67% vs 0.94% OR=1.17 (95% CI [1.06-1.30] p=0.002), additionally there was a lower rate of post-operative cardiac complications in the 4th quartile compared to all other quarters (p < 0.05) and less generalized and localized post-operative infections in the highest quartile compared to the lowest quartile, 0.45% vs 0.54% OR= 1.17 (95% CI[1.04-1.32] p=0.006) and 0.72% vs 0.95% OR=1.22 (95% CI [1.12-1.34] p< 0.001) respectively

Conclusion : Reduced household income significantly impacts postoperative outcomes following lumbar fusion and should be taken into consideration during the perioperative period.