Comparative Analysis Between Urban versus Rural Hospitals for Patient Demographics and Perioperative Outcomes After Lumbar Spinal Fusion: an analysis of the National Inpatient Sample (2009-2020)

Introduction: Rural location of patient’s primary residence has previously been shown to be associated with worse outcomes secondary to limited resource availability in these parts of the United States. However, there is paucity of literature investigating the possible impacts a rural hospital location may have on the outcomes of lumbar spine fusions.

Methods: Using the National Inpatient Sample (NIS) database a search identified all patients who underwent a lumbar spinal fusion in the years, 2009-2020. These patients were then separated according to whether the treatment hospital was considered rural or urban. Univariate and multivariate linear/logistic regression models were utilized to analyze the data.

Results: A total of 2,863,816 patients were identified from this database, where 120,298 (4.2%) patients had their operation at a rural hospital, with the remaining patients in an urban hospital. Patients in the urban cohort were younger (P <.001), more likely to have private insurance (39.81% vs. 31.95%, P<.001), and have a decreased rate of patients in the first (22.52% vs. 43.00%, P<.001)) and second (25.96% vs. 38.90%, P<.001) quartiles of median household income when compared to the rural cohort. The urban hospital patients had significantly increased rates of respiratory (4.49% vs. 3.37%), urinary (5.25% vs. 4.15%), infectious (0.49% vs 0.32%), venous thrombotic (0.57% vs. 0.24%, P<.001), and neurological (0.79% vs. 0.36%) (all P <.001) complications after surgery. On multivariate analysis, urban patients have significant increased odds of the same postoperative complications: respiratory (OR, 1.48; 95% CI, 1.26-1.74), urinary (OR, 1.34; 95% CI, 1.20-1.50), infection (OR, 1.63; 95% CI, 1.23-2.17), venous thrombotic (OR, 1.79; 95% CI, 1.32-2.41), neurological injury (OR, 1.92; 95% CI, 1.46-2.53), and localized infection (OR, 1.65; 95% CI, 1.25-2.17) (all P <.001).

Conclusion : Patients undergoing lumbar fusions experience significantly different outcomes based on rurality or urbanicity of operative hospital. Future research should investigate this to potentially resolve these disparities.