Medical Student Department of Neurosurgery, University of Illinois at Chicago Chicago, IL, US
Introduction: Thoracolumbar fractures represent the majority of spine fractures, with 50% occurring at at T11-L2. Homelessness is a common cause of healthcare inequality in the United States that can delay and complicate care. To date, there has been no studies evaluating the effect of homelessness on inpatient management and outcomes following thoracolumbar spine fractures.
Methods: In this retrospective cohort study, the 2021 National Trauma Data Bank data was queried for adult patients with a thoracolumbar fracture injury. Missing data was imputed using the missForest algorithm. Propensity score matching was performed with 22 variables, including demographics, comorbidities, insurance type, and indicators of injury severity. Matching was performed using one-to-one k-nearest neighbor matching without replacement. Balance was assessed with a standard mean difference (SMD) threshold of 0.1. Descriptive statistics were performed with independent or paired Student’s t-tests and Pearson’s chi-squared or McNemar’s tests for pre- or post-match comparisons, respectively.
Results: A total of 75750 eligible patients were included; 956 were unhoused and 74794 were housed. The mean age was 41.61 years, 68.54% were male, 69.43% were White,15.17% were Black, and 16.74% were Hispanic. At baseline, unhoused patients were more likely to have alcoholism, substance use, psychiatric disorders, and smoking, and have public health insurance. After matching, 956 unique housed patients were matched with 956 unhoused patients. Equal balance was achieved in all match variables except for history of smoking (SMD=0.1). The rate of surgical fusion was comparable between groups (5.75% vs. 7.22%, p=0.76). The unhoused group experienced longer hospital length of stay (LOS; 14.87 vs. 7.06 days, p< 0.01) and intensive care unit LOS (5.92 vs. 4.34 days, p< 0.01), lower rate of discharge to self-care (46.03% vs 57.11%, p< 0.01) and higher rate of discharge to a skilled nursing facility (13.81% vs. 4.71%, p=0.04).
Conclusion : Unhoused patients experience significantly longer hospital LOS and are less likely to be discharged to self-care after thoracolumbar fractures. This disparity leads to greatly increased healthcare costs and resource utilization, which represents a burden for patients and surgical centers alike. Improved social work and patient care coordination resources are warranted to reduce unnecessary hospitalization for unhoused patients following spine surgery.
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