Social Vulnerability Index is Associated With Increased Emergency Department Utilization and Persistent Opioid Use After Elective Lumbar Decompression Surgery.

IntroductionSocial determinants of health have been shown to influence various outcome measures after elective orthopaedic procedures, including spine surgery. However, there has been limited research investigating the influence between social determinants of health and healthcare resource utilization after elective spine surgery. The purpose of this study was to investigate the influence of social vulnerability on opioid use, healthcare utilization, and patient-report outcome measures (PROMs) after elective lumbar decompression procedures.MethodsPatients undergoing elective 1- or 2- level lumbar decompression procedures between 2013 and 2018 at a single tertiary medical center were retrospectively identified. Various demographic variables, including the ZIP code of residence for each patient were reported. The Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI) scores were calculated for each patient. Social vulnerability was defined as combined socioeconomic and housing vulnerability scores in the upper quartile. Several outcome measures were compared between patients with or without social vulnerability. The outcomes of interest included healthcare utilization and patient-reported outcome measures - pain interference (PI) and physical function (PF) within 1 year postoperatively. Healthcare utilization metrics included opioid use, emergency department visits, urgent care visits, MRI studies, pain management referrals, and revision surgeries. The minimal clinically important difference (MCID) was defined as 8 for both PI and PF scores.ResultsA total of 216 patients were included in the cohort -58 patients met criteria for social vulnerability. Patients with social vulnerability were more likely to be female and ASA class 2. Otherwise, patient demographics and medical comorbidities were similar between the 2 groups. Patients with social vulnerability were more likely to utilize the emergency department within 1-year postoperatively and to have persistent opioid use at both 6 months and 1 year postoperatively. On multivariate regression, SVI was independently associated with pre-operative opioid use, post-operative emergency department utilization, and persistent opioid use after surgery. Relative improvement in PI and PF scores and rates of MCID attainment were similar between groups.ConclusionsPatients with social disparities were more likely to utilize the emergency department and have persistent opioid use at 6 months and 1 year postoperatively from elective lumbar decompression procedures.