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Oduguwa E, Azam F, Jenkins A, Farid M, Wang J, Possu A, Tao J, Adeyemo E, Mofor P, Kenfack YJ, Hall K, Barrie U, Aoun SG, Bagley CA. Exploring Health Inequalities and Presurgical Attitudes on Postsurgical Outcomes in Spine Surgery. World Neurosurg 2024:S1878-8750(24)01336-6. [PMID: 39097086 DOI: 10.1016/j.wneu.2024.07.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/27/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVE The influence of social determinants of health on health disparities is substantial. However, their impact on postsurgical outcomes in spine can be challenging to ascertain at the community level. This study aims to explore the interplay between presurgical attitudes, area deprivation index (ADI), income, employment status, and body mass index (BMI) on postsurgical outcomes at 3, 6, 9, and 12 months after elective spine surgery. METHODS The study involved 127 patients who underwent elective spine surgery between August 2021 and August 2022 at a large academic institution. The main objective involved a prospective analysis of presurgical attitudes, coupled with a retrospective assessment of ADI, income, employment status, and BMI over 3, 6, 9, and 12 months following elective spine surgery using a univariate analysis. RESULTS Utilizing the univariate analyses, ADI displayed a significant correlation with increased Patient-Reported Outcomes Measurement Information System and Visual Analog Scale scores both before surgery and at the 3-, 6-, and 9-month postsurgical intervals (P < 0.05). One year after surgery, patients in the lowest income group (annual income under $25,000) consistently demonstrated the highest Patient-Reported Outcomes Measurement Information System pain (8.00, P = 0.022). Patients who were not employed had significantly lower levels of social support (P = 0.042) and confidence in the health care system (P = 0.009). Individuals who were unemployed were most likely to be readmitted six weeks after surgery (P < 0.001). CONCLUSIONS Presurgical attitudes, ADI, income, employment status, and BMI were important factors associated with improved surgical outcome measurements, indicating potential focal points for combating health disparities in spinal surgery patients.
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Affiliation(s)
- Emmanuella Oduguwa
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - Faraaz Azam
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Abigail Jenkins
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Farid
- Weill Cornell Medical College, Cornell University, New York City, New York, USA
| | - Jason Wang
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Alejandra Possu
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jonathan Tao
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emmanuel Adeyemo
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, Michigan, USA
| | - Paula Mofor
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yves Jordan Kenfack
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kristen Hall
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Umaru Barrie
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Salah G Aoun
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Carlos A Bagley
- Department of Neurological Surgery, Saint Luke's Neurological & Spine Surgery, Kansas City, Missouri, USA
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Tang T, Wan B, Zhang X, Zhang A. Impact of Obesity on Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgeries: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 185:e835-e849. [PMID: 38432511 DOI: 10.1016/j.wneu.2024.02.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To evaluate the impact of obesity on various outcomes in patients undergoing minimally invasive transforaminal lumbar interbody fusion (TLIF) surgeries. METHODS PubMed, Scopus, Embase, and Cochrane Library databases were screened for studies reporting outcomes in obese and nonobese patients undergoing TLIF surgeries. Studies reporting operative time, estimated blood loss, length of hospital stay, incidence of pseudoarthrosis, Oswestry Disability Index (ODI) scores, pain scores (Visual Analog Scale, VAS), and PROMIS PF scores were included. A qualitative and quantitative analysis was performed to calculate mean differences or odds ratios (ORs) using random-effects models. RESULTS Fourteen good-quality studies were included in this review, with a combined sample size of 4,889 participants. The analysis revealed that patients with obesity had slightly longer operative times compared to patients with normal weight, with a mean difference of 14.87 minutes, though not significant. Similarly, morbidly obese patients had a mean difference of 21.44 minutes in operative time. Estimated blood loss was comparable in both groups. However, morbidly obese patients had longer hospital stays, with a mean difference of 8.18 days and obese patients have 20% higher odds of experiencing complications compared to nonobese patients. The incidence of pseudoarthrosis, ODI scores, or pain scores (VAS back and leg) were similar in obese and normal weight patients. CONCLUSIONS Obesity, particularly morbid obesity, may have an impact on certain outcomes in patients undergoing minimally invasive TLIF surgeries. Morbidly obese patients tend to have significantly longer operative times with significantly longer hospital stays than nonobese patients.
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Affiliation(s)
- Tao Tang
- Department of Second Orthopedics, First People's Hospital of Jiashan County, Jiashan County, China
| | - Bingwen Wan
- Department of Second Orthopedics, First People's Hospital of Jiashan County, Jiashan County, China
| | - Xu Zhang
- Department of Second Orthopedics, First People's Hospital of Jiashan County, Jiashan County, China
| | - Alei Zhang
- Department of Second Orthopedics, First People's Hospital of Jiashan County, Jiashan County, China.
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Nie JW, Hartman TJ, Pawlowski H, Prabhu MC, Vanjani NN, Oyetayo OO, Singh K. Impact of Ambulatory Setting for Workers' Compensation Patients Undergoing One-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion and Review of the Literature. World Neurosurg 2022; 167:e251-e267. [PMID: 35948231 DOI: 10.1016/j.wneu.2022.07.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To compare perioperative characteristics and patient-reported outcome measures (PROMs) in workers' compensation (WC) patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in either the inpatient/outpatient setting. METHODS Patients with WC undergoing 1-level MIS-TLIF were included. Patients were separated into inpatient/outpatient groups and demographically propensity score matched. PROMs included visual analog scale (VAS) back/VAS leg/Oswestry Disability Index (ODI)/12-item Short Form Physical Composite Score (SF-12 PCS)/Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) preoperatively and 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. Results were compared preoperatively and postoperatively and between cohorts. Minimum clinically important difference (MCID) achievement was determined through comparison with values established in the literature. RESULTS A total of 216 patients were included (184 inpatient). The inpatient cohort (IC) showed worse perioperative outcomes in multiple measures (P < 0.034; all). The IC improved in all PROMs (P < 0.038; all), besides ODI at 6 weeks, SF-12 PCS at 6 weeks/6 months/1 year, and PROMIS-PF at 6 weeks. The outpatient cohort (OC) improved in VAS back at all time points and VAS leg at 6 months (P < 0.033; all). Between cohorts, the OC showed better scores with VAS leg/ODI/SF-12 PCS/PROMIS-PF at multiple time points (P < 0.031; all). Most of the IC achieved MCID, aside from ODI, whereas the OC achieved MCID in SF-12 PCS. MCID achievement between cohorts was higher in the IC at PROMIS-PF at 1 year and VAS back overall (P < 0.034; all). CONCLUSIONS Despite more comorbidities and worse perioperative measures, the IC showed improved PROMs from preoperative to ≥1 follow-up visit, whereas the OC had improvement with only VAS back and leg. The IC showed multiple MCID achievements, whereas the OC showed MCID in only SF-12 PCS. These findings may help guide a surgeon's decision making between inpatient/outpatient lumbar surgery in the WC population.
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Affiliation(s)
- James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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