Low Household Income Increases Hospital Length of Stay and Decreases Home Discharge Rates in Lumbar Fusion
STUDY DESIGN: Retrospective Matched Cohort Study.
OBJECTIVES: Low median household income (MHI) has been correlated with worsened surgical outcomes, but few studies have rigorously controlled for demographic and medical factors at the patient level. This study isolates the relationship between MHI and surgical outcomes in a lumbar fusion cohort using coarsened exact matching.
METHODS: Patients undergoing single-level, posterior lumbar fusion at a single institution were consecutively enrolled and retrospectively analyzed (n = 4263). Zip code was cross-referenced to census data to derive MHI. Univariate regression correlated MHI to outcomes. Patients with low MHI were matched to those with high MHI based on demographic and medical factors. Outcomes evaluated included complications, length of stay, discharge disposition, 30- and 90 day readmissions, emergency department (ED) visits, reoperations, and mortality.
RESULTS: By univariate analysis, MHI was significantly associated with 30- and 90 day readmission, ED visits, reoperation, and non-home discharge, but not mortality. After exact matching (n = 270), low-income patients had higher odds of non-home discharge (OR = 2.5, P = .016) and higher length of stay (mean 100.2 vs 92.6, P = .02). There were no differences in surgical complications, ED visits, readmissions, or reoperations between matched groups.
CONCLUSIONS: Low MHI was significantly associated with adverse short-term outcomes from lumbar fusion. A matched analysis controlling for confounding variables uncovered longer lengths of stay and higher rates of discharge to post-acute care (vs home) in lower MHI patients. Socioeconomic disparities affect health beyond access to care, worsen surgical outcomes, and impose costs on healthcare systems. Targeted interventions must be implemented to mitigate these disparities.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Global spine journal - (2024) vom: 21. März, Seite 21925682241239609 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Gallagher, Ryan S [VerfasserIn] |
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| Links: |
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| Themen: |
Discharge disposition |
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| Anmerkungen: |
Date Revised 22.03.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1177/21925682241239609 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM370045122 |
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| 500 | |a Date Revised 22.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a STUDY DESIGN: Retrospective Matched Cohort Study | ||
| 520 | |a OBJECTIVES: Low median household income (MHI) has been correlated with worsened surgical outcomes, but few studies have rigorously controlled for demographic and medical factors at the patient level. This study isolates the relationship between MHI and surgical outcomes in a lumbar fusion cohort using coarsened exact matching | ||
| 520 | |a METHODS: Patients undergoing single-level, posterior lumbar fusion at a single institution were consecutively enrolled and retrospectively analyzed (n = 4263). Zip code was cross-referenced to census data to derive MHI. Univariate regression correlated MHI to outcomes. Patients with low MHI were matched to those with high MHI based on demographic and medical factors. Outcomes evaluated included complications, length of stay, discharge disposition, 30- and 90 day readmissions, emergency department (ED) visits, reoperations, and mortality | ||
| 520 | |a RESULTS: By univariate analysis, MHI was significantly associated with 30- and 90 day readmission, ED visits, reoperation, and non-home discharge, but not mortality. After exact matching (n = 270), low-income patients had higher odds of non-home discharge (OR = 2.5, P = .016) and higher length of stay (mean 100.2 vs 92.6, P = .02). There were no differences in surgical complications, ED visits, readmissions, or reoperations between matched groups | ||
| 520 | |a CONCLUSIONS: Low MHI was significantly associated with adverse short-term outcomes from lumbar fusion. A matched analysis controlling for confounding variables uncovered longer lengths of stay and higher rates of discharge to post-acute care (vs home) in lower MHI patients. Socioeconomic disparities affect health beyond access to care, worsen surgical outcomes, and impose costs on healthcare systems. Targeted interventions must be implemented to mitigate these disparities | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a discharge disposition | |
| 650 | 4 | |a household income | |
| 650 | 4 | |a length of stay | |
| 650 | 4 | |a lumbar fusion | |
| 700 | 1 | |a Karsalia, Ritesh |e verfasserin |4 aut | |
| 700 | 1 | |a Borja, Austin J |e verfasserin |4 aut | |
| 700 | 1 | |a Malhotra, Emelia G |e verfasserin |4 aut | |
| 700 | 1 | |a Punchak, Maria A |e verfasserin |4 aut | |
| 700 | 1 | |a Na, Jianbo |e verfasserin |4 aut | |
| 700 | 1 | |a McClintock, Scott D |e verfasserin |4 aut | |
| 700 | 1 | |a Malhotra, Neil R |e verfasserin |4 aut | |
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