PMID- 35090132 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240517 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 37 IP - 1 DP - 2022 Jul 1 TI - Social risk factors predicting outcomes of cervical myelopathy surgery. PG - 41-48 LID - 10.3171/2021.12.SPINE21874 [doi] AB - OBJECTIVE: Combinations of certain social risk factors of race, sex, education, socioeconomic status (SES), insurance, education, employment, and one's housing situation have been associated with poorer pain and disability outcomes after lumbar spine surgery. To date, an exploration of such factors in patients with cervical spine surgery has not been conducted. The objective of the current work was to 1) define the social risk phenotypes of individuals who have undergone cervical spine surgery for myelopathy and 2) analyze their predictive capacity toward disability, pain, quality of life, and patient satisfaction-based outcomes. METHODS: The Cervical Myelopathy Quality Outcomes Database was queried for the period from January 2016 to December 2018. Race/ethnicity, educational attainment, SES, insurance payer, and employment status were modeled into unique social phenotypes using latent class analyses. Proportions of social groups were analyzed for demonstrating a minimal clinically important difference (MCID) of 30% from baseline for disability, neck and arm pain, quality of life, and patient satisfaction at the 3-month and 1-year follow-ups. RESULTS: A total of 730 individuals who had undergone cervical myelopathy surgery were included in the final cohort. Latent class analysis identified 2 subgroups: 1) high risk (non-White race and ethnicity, lower educational attainment, not working, poor insurance, and predominantly lower SES), n = 268, 36.7% (class 1); and 2) low risk (White, employed with good insurance, and higher education and SES), n = 462, 63.3% (class 2). For both 3-month and 1-year outcomes, the high-risk group (class 1) had decreased odds (all p < 0.05) of attaining an MCID score in disability, neck/arm pain, and health-related quality of life. Being in the low-risk group (class 2) resulted in an increased odds of attaining an MCID score in disability, neck/arm pain, and health-related quality of life. Neither group had increased or decreased odds of being satisfied with surgery. CONCLUSIONS: Although 2 groups underwent similar surgical approaches, the social phenotype involving non-White race/ethnicity, poor insurance, lower SES, and poor employment did not meet MCIDs for a variety of outcome measures. This finding should prompt surgeons to proactively incorporate socially conscience care pathways within healthcare systems, as well as to optimize community-based resources to improve outcomes and personalize care for populations at social risk. FAU - Rethorn, Zachary D AU - Rethorn ZD AD - 1Department of Orthopaedics, Duke University, Durham. AD - 19Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina. FAU - Cook, Chad E AU - Cook CE AD - 1Department of Orthopaedics, Duke University, Durham. AD - 3Duke Clinical Research Institute, Duke University, Durham, North Carolina. FAU - Park, Christine AU - Park C AD - 15Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina. FAU - Somers, Tamara AU - Somers T AD - 3Duke Clinical Research Institute, Duke University, Durham, North Carolina. FAU - Mummaneni, Praveen V AU - Mummaneni PV AD - 4Department of Neurological Surgery, University of California, San Francisco, California. FAU - Chan, Andrew K AU - Chan AK AD - 4Department of Neurological Surgery, University of California, San Francisco, California. FAU - Pennicooke, Brenton H AU - Pennicooke BH AD - 5Department of Neurosurgery, Washington University in St. Louis, Missouri. FAU - Bisson, Erica F AU - Bisson EF AD - 6Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah. FAU - Asher, Anthony L AU - Asher AL AD - 7Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas HealthCare System, Charlotte, North Carolina. FAU - Buchholz, Avery L AU - Buchholz AL AD - 8Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia. FAU - Bydon, Mohamad AU - Bydon M AD - 9Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. FAU - Alvi, Mohammed Ali AU - Alvi MA AD - 9Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. FAU - Coric, Domagoj AU - Coric D AD - 7Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas HealthCare System, Charlotte, North Carolina. FAU - Foley, Kevin T AU - Foley KT AD - 10Department of Neurosurgery, University of Tennessee and Semmes-Murphey Clinic, Memphis, Tennessee. FAU - Fu, Kai-Ming AU - Fu KM AD - 11Department of Neurological Surgery, Weill Cornell Medicine, New York, New York. FAU - Knightly, John J AU - Knightly JJ AD - 12Altair Health Spine and Wellness, Morristown, New Jersey. FAU - Meyer, Scott AU - Meyer S AD - 12Altair Health Spine and Wellness, Morristown, New Jersey. FAU - Park, Paul AU - Park P AD - 13Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan. FAU - Potts, Eric A AU - Potts EA AD - 14Goodman Campbell Brain and Spine, Indianapolis, Indiana. FAU - Shaffrey, Christopher I AU - Shaffrey CI AD - 15Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina. FAU - Shaffrey, Mark AU - Shaffrey M AD - 8Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia. FAU - Than, Khoi D AU - Than KD AD - 15Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina. FAU - Tumialan, Luis AU - Tumialan L AD - 16Barrow Neurological Institute, Phoenix, Arizona. FAU - Turner, Jay D AU - Turner JD AD - 16Barrow Neurological Institute, Phoenix, Arizona. FAU - Upadhyaya, Cheerag D AU - Upadhyaya CD AD - 17Saint Luke's Neurological and Spine Surgery, Kansas City, Missouri. FAU - Wang, Michael Y AU - Wang MY AD - 18Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and. FAU - Gottfried, Oren AU - Gottfried O AD - 15Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina. LA - eng PT - Journal Article DEP - 20220128 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM OTO - NOTNLM OT - cervical myelopathy OT - patient outcomes OT - social determinants of health OT - social phenotypes OT - social risk factors EDAT- 2022/01/29 06:00 MHDA- 2022/01/29 06:01 CRDT- 2022/01/28 20:03 PHST- 2021/06/27 00:00 [received] PHST- 2021/12/02 00:00 [accepted] PHST- 2022/01/29 06:01 [medline] PHST- 2022/01/29 06:00 [pubmed] PHST- 2022/01/28 20:03 [entrez] AID - 2021.12.SPINE21874 [pii] AID - 10.3171/2021.12.SPINE21874 [doi] PST - epublish SO - J Neurosurg Spine. 2022 Jan 28;37(1):41-48. doi: 10.3171/2021.12.SPINE21874. Print 2022 Jul 1.