Impact of the Social Deprivation Index on Patient Reported Outcomes after the Surgical Management of Degenerative Cervical Spine Disease: a Quality Outcomes Database Study

Introduction: The Social Deprivation Index (SDI) was developed to quantify levels of disadvantage across small areas, evaluate their associations with health outcomes, and address health inequities. The aim of this study is to investigate the impact of social deprivation on patient reported outcomes amongst patients who underwent elective surgical management of degenerative cervical spine disease.

Methods: The prospectively collected Cervical spine module of the Quality Outcomes Database (QOD) was retrospectively queried, and patient zip codes were utilized to derive the SDI. The SDI is a composite measure of seven demographic characteristics. Patients were divided into quintiles based on the SDI, and further dichotomized into two groups: least deprived group (bottom 20%) and most deprived group (top 20%). The primary outcomes of interest were patient reported outcomes at 3-month follow-up.

Results: Patients in the least deprived group (n=5032) were generally healthier at baseline compared to those in the most deprived group (n=4937) based on comorbidities such as COPD, diabetes, and osteoarthritis. Additionally, they had lower estimated blood loss, shorter surgical duration, and a shorter length of stay. Non-routine discharges were also less common in the least deprived group (3.2% vs. 4.5%,p < 0.01). At three months post-operatively, the least deprived group demonstrated better patient-reported outcomes. They had significantly lower mean Neck Disability Index (NDI) scores (18.93 ± 16.45 vs 23.97 ± 19.16,p < 0.01) and higher patient satisfaction (92.1% vs 88.3%, p< 0.01). Pain levels, including neck pain (2.4±2.4 vs 3.2±2.8,p < 0.01) and arm pain (1.7±2.4 vs 2.4±2.9,p < 0.01), were lower in the least deprived group. Quality of life (EQ5D) was higher among the least deprived (0.81±0.18 vs 0.74 ± 0.21,p < 0.01).

Conclusion : These results highlight the significant influence of social deprivation on clinical outcomes and healthcare utilization in surgical patients. Patients in the most deprived group not only presented with worse baseline health conditions but also experienced poorer post-operative outcomes, including higher pain levels, lower satisfaction, and reduced quality of life. Addressing social determinants of health, such as those reflected in the SDI, may be essential in improving surgical outcomes for patients with degenerative cervical spine disease.