Faculty, Staff and Student Publications

Publication Date

6-1-2025

Journal

North American Spine Society Journal

DOI

10.1016/j.xnsj.2025.100611

PMID

40492235

PMCID

PMC12148405

PubMedCentral® Posted Date

4-17-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Background: In the US, over half of all cervical and lumbar arthrodesis spine surgeries are for people ≥60 years of age. The extent to which adverse outcomes vary by social (eg, disadvantaged neighborhoods) and demographic factors have been scarcely investigated in spine surgery. We investigated the association of social, demographic, and clinical factors with complications, 30-day readmission, and 30-day mortality in older Veterans undergoing elective spine surgery.

Methods: Veterans (N=5,277) aged ≥65 years who underwent inpatient elective spine surgery for degenerative disease in the Veterans Affairs Surgical Quality Improvement Program (VASQIP) comprised our retrospective cohort. VASQIP (2013-2019) data were merged with other Veterans Health Administration (VHA) and Medicare administrative data. Multivariable logistic regression models were estimated to assess the associations of social (rurality, Area Deprivation Index [ADI]) and clinical (frailty, comorbidity) factors with complications, 30-day readmission, and 30-day mortality. The ADI is a neighborhood-level socioeconomic disadvantage ranking using 17 variables (eg, housing quality). We defined highly disadvantaged as ADI>85.

Results: Veterans aged 65-74 years comprised 82.7%; 77.9% identified as White, 15.1% as Black, and 7.0% as another race; and 97.1% were male. Over one-third (38.9%) lived in rural areas and 12.3% lived in highly disadvantaged neighborhoods. Readmission and mortality were 10.0% and 0.6%, respectively, and 6.0% experienced complications. Rurality and ADI>85 were not associated with complications, 30-day readmission, or 30-day mortality. Frailty, comorbidity, class-3 obesity, and operative stress were associated with adverse outcomes.

Conclusions: Social (rurality, ADI>85) and demographic variables were not associated with complication, 30-day readmission, or 30-day mortality in older Veterans following elective spine surgery. While clinical factors (frailty, co-morbidity, class-3 obesity, and operative stress score) were associated with adverse outcomes, Veterans in this study did not experience disparities in medical outcomes due to social vulnerability. Untangling mechanisms connecting social and clinical factors may improve outcomes.

Keywords

Area Deprivation Index, Older adult, Socioeconomic disadvantage, Postoperative Outcomes, Social Determinants of Health, Social Risk Factors, Veteran

Published Open-Access

yes

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.