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The influence of social determinants of health on single-level anterior cervical discectomy and fusion outcomes.

OBJECTIVE
Methods of reducing complications in individuals electing to undergo anterior cervical discectomy and fusion (ACDF) rely upon understanding at-risk patient populations, among other factors. This study aims to investigate the interplay between social determinants of health (SDOH) and postoperative complication rates, length of stay, revision surgery, and rates of postoperative readmission at 30 and 90 days in individuals electing to have single-level ACDF.


METHODS
Using MARINER30, a database that contains claims information from all payers, patients were identified who underwent single-level ACDF between 2010 and 2019. Identification of patients experiencing disparities in 1 of 6 categories of SDOH was completed using ICD-9 and ICD-10 (International Classifications of Diseases, Ninth and Tenth Revisions) codes. The population was propensity matched into 2 cohorts based on comorbidity status: those with SDOH versus those without.


RESULTS
A total of 10,030 patients were analyzed; there were 5015 (50.0%) in each cohort. The rates of any postoperative complication (12.0% vs 4.6%, p < 0.001); pseudarthrosis (3.4% vs 2.6%, p = 0.017); instrumentation removal (1.8% vs 1.2%, p = 0.033); length of stay (2.54 ± 5.9 days vs 2.08 ± 5.07 days, p < 0.001 [mean ± SD]); and revision surgery (9.7% vs 4.2%, p < 0.001) were higher in the SDOH group compared to patients without SDOH, respectively. Patients with any SDOH had higher odds of perioperative complications (OR 2.8, 95% CI 2.43-3.33), pseudarthrosis (OR 1.3, 95% CI 1.06-1.68), revision surgery (OR 2.4, 95% CI 2.04-2.85), and instrumentation removal (OR 1.4, 95% CI 1.04-2.00).


CONCLUSIONS
In patients who underwent single-level ACDF, there is an association between SDOH and higher complication rates, longer stay, increased need for instrumentation removal, and likelihood of revision surgery.