The Impact of Social Determinants of Health on Discharge Disposition Following One- and Two-Level Posterior Interbody Fusion

Michelle A Zabat; Lindsay Kim; Priscilla P Varghese; Brooke K O'Connell; Yong H Kim; Charla R Fischer

doi:10.7759/cureus.52939

The Impact of Social Determinants of Health on Discharge Disposition Following One- and Two-Level Posterior Interbody Fusion

Cureus. 2024 Jan 25;16(1):e52939. doi: 10.7759/cureus.52939. eCollection 2024 Jan.

Authors

Michelle A Zabat¹, Lindsay Kim², Priscilla P Varghese², Brooke K O'Connell¹, Yong H Kim¹, Charla R Fischer¹

Affiliations

¹ Orthopaedic Surgery, New York University (NYU) Grossman School of Medicine, New York, USA.
² Orthopaedic Surgery, State University of New York (SUNY) Downstate Health Sciences University, College of Medicine, Brooklyn, USA.

Abstract

Background Current research is limited in exploring the impact of social determinants of health (SDOH) on the discharge location within elective spine surgery. Further understanding of the influence of SDOH on disposition is necessary to improve outcomes. This study explores how SDOH influence discharge disposition for patients undergoing one- or two-level posterior interbody fusion (TLIF/PLIF). Methods This was a retrospective propensity-matched cohort study. Patients who underwent TLIF/PLIF between 2017 and 2020 at a single academic medical center were identified. The chart review gathered demographics, perioperative characteristics, intra/post-operative complications, discharge disposition, and 90-day outcomes. Discharge dispositions included subacute nursing facility (SNF), home with self-care (HSC), home with health services (HHS), and acute rehab facility (ARF). Demographic, perioperative, and disposition outcomes were analyzed by chi-square analysis and one-way ANOVA based on gender, race, and income quartiles. Results Propensity score matching for significant demographic factors isolated 326 patients. The rate of discharge to SNF was higher in females compared to males (25.00% vs 10.56%; p=0.001). Men were discharged to home at a higher rate than women (75.4% vs 61.95%; p=0.010). LatinX patients had the highest rate of home discharge, followed by Asians, Caucasians, and African Americans (83.33% vs 70.31% vs 66.45% vs 65.90%; p<0.001). The post hoc Tukey test demonstrated statistically significant differences between Asians and all other races in the context of age and BMI. Additionally, patients discharged to SNF showed the highest Charlson comorbidity index (CCI) score, followed by those at ARF, HHS, and HSC (4.36 vs 4.05 vs 2.87 vs 2.37; p<0.001). The estimated median income for the cohort ranged from $52,000 to $250,001, with no significant differences in income seen across comparisons. Conclusion Discharge disposition following one- or two-level TLIF/PLIF shows significant association with gender and race. No association was seen when comparing discharge rates among zip code-level median income quartiles.

Keywords: discharge disposition; posterior lumbar interbody fusion (plif); social determinants of health (sdoh); socioeconomic disparities; transforaminal lumbar interbody fusion (tlif).