Neighborhood-level measures of socioeconomic status impact healthcare utilization and surgical outcomes in cervical spondylotic myelopathy patients in the Deep South

Objective: The aim of this study was to evaluate the association of neighborhood-level and individual-level measures of socioeconomic status with readmission, complication rates, and postoperative length of stay of patients with cervical spondylotic myelopathy (CSM) in the Deep South.

Methods: The authors identified all patients undergoing surgical intervention for the treatment of CSM from November 2010 to February 2022 using Current Procedural Terminology and ICD-9/ICD-10 codes. Patient demographic, socioeconomic, perioperative, and postoperative data for each patient were collected via review of the electronic medical record. Patient addresses underwent geospatial analysis and were used to extract the Area of Deprivation Index (ADI). Patients with ADIs greater than 75 were considered highly deprived. Univariate comparison and multivariate logistic regressions were used to analyze the relationship between socioeconomic variables and outcomes of interest.

Results: In total, 490 patients with CSM met the inclusion and exclusion criteria. The median age at the time of surgery was 60 (IQR 54-68) years. The median ADI was 75 (IQR 57-90). On multivariate regression analysis, unemployment was found to predict readmission within 1 year of index surgery (OR 4.08, 95% CI 1.87-9.61; p < 0.001). Having high ADI (OR 0.53, 95% CI 0.29-0.94; p = 0.033) and being African American (OR 0.51, 95% CI 0.26-0.97; p = 0.043) were found to be independently protective of readmission. Unemployment was found to be an independent predictor of postoperative complications (OR 3.65, 95% CI 1.52-9.82; p = 0.006). On multivariate regression analysis, high ADI (OR 1.69, 95% CI 1.02-2.81; p = 0.042) and living in a skilled nursing facility/residential facility (OR 8.84, 95% CI 3.08-28.5, p < 0.001) were independent predictors of prolonged length of hospital stay postoperatively.

Conclusions: This is the first single-institution study investigating the influence of neighborhood-level and employment status on readmission, complications, and lengths of stay in patients with CSM in the Deep South. Neighborhood-level measures of socioeconomic status play complex and unique roles in CSM patient outcomes in the Deep South, highlighting the Deep South as a potentially unique geographic region in terms of neurosurgical outcomes. Further research is needed to evaluate methods of alleviating these disparities and improve patient outcomes.