Study Design: 

Retrospective cohort study.

Objective: 

To determine whether: (1) patients from communities of socioeconomic distress have higher readmission rates or postoperative healthcare resource utilization and (2) there are differences in patient-reported outcome measures (PROMs) based on socioeconomic distress.

Summary of Background Data: 

Socioeconomic disparities affect health outcomes, but little evidence exists demonstrating the impact of socioeconomic distress on postoperative resource utilization or PROMs.

Methods: 

A retrospective review was performed on patients who underwent lumbar fusion at a single tertiary academic center from January 1, 2011 to June 30, 2021. Patients were classified according to the distressed communities index. Hospital readmission, postoperative prescriptions, patient telephone calls, follow-up office visits, and PROMs were recorded. Multivariate analysis with logistic, negative binomial regression or Poisson regression were used to investigate the effects of distressed communities index on postoperative resource utilization. Alpha was set at P<0.05.

Results: 

A total of 4472 patients were included for analysis. Readmission risk was higher in distressed communities (odds ratio, 1.75; 95% confidence interval, 1.06–2.87; P=0.028). Patients from distressed communities (odds ratio, 3.94; 95% confidence interval, 1.60–9.72; P=0.003) were also more likely to be readmitted for medical, but not surgical causes (P=0.514), and distressed patients had worse preoperative (visual analog-scale Back, P<0.001) and postoperative (Oswestry disability index, P=0.048; visual analog-scale Leg, P=0.013) PROMs, while maintaining similar magnitudes of clinical improvement. Patients from distressed communities were more likely to be discharged to a nursing facility and inpatient rehabilitation unit (25.5%, P=0.032). The race was not independently associated with readmissions (P=0.228).

Conclusion: 

Socioeconomic distress is associated with increased postoperative health resource utilization. Patients from distressed communities have worse preoperative PROMs, but the overall magnitude of improvement is similar across all classes.

Level of Evidence: 

Level IV.

中文翻译：

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腰椎融合术后来自社会经济困难社区的患者的再入院和资源利用

学习规划： 

回顾性队列研究。

客观的： 

确定：(1) 来自社会经济困境社区的患者是否具有较高的再入院率或术后医疗资源利用率，以及 (2) 基于社会经济困境的患者报告结果测量 (PROM) 是否存在差异。

背景数据摘要： 

社会经济差异会影响健康结果，但很少有证据表明社会经济困难对术后资源利用或 PROM 的影响。

方法： 

对2011年1月1日至2021年6月30日在单一三级学术中心接受腰椎融合术的患者进行回顾性评价。根据贫困社区指数对患者进行分类。再次入院、术后处方、患者电话、后续办公室就诊和 PROM 均被记录。采用逻辑回归、负二项回归或泊松回归的多变量分析来研究贫困社区指数对术后资源利用的影响。Alpha 设置为P <0.05。

结果： 

总共 4472 名患者被纳入分析。贫困社区的再入院风险较高（比值比，1.75；95% 置信区间，1.06–2.87；P = 0.028）。来自贫困社区的患者（比值比，3.94；95% 置信区间，1.60-9.72；P = 0.003）也更有可能因内科原因而非手术原因再次入院（P = 0.514），而且贫困患者的术前情况更差（视觉模拟量表背部，P <0.001）和术后（Oswestry 残疾指数，P = 0.048；视觉模拟量表腿部，P = 0.013）PROM，同时保持相似程度的临床改善。来自贫困社区的患者更有可能出院到护理机构和住院康复科（25.5%，P =0.032）。种族与再入院并不独立相关（P =0.228）。

结论： 

社会经济困难与术后卫生资源利用率的增加有关。来自贫困社区的患者术前 PROM 较差，但所有类别的总体改善程度相似。

证据级别： 

四级。