Impact of Educational Background on Preoperative Disease Severity and Postoperative Outcomes Among Patients With Cervical Spondylotic Myelopathy

Author:

Agarwal Nitin12,DiGiorgio Anthony3,Michalopoulos Giorgos D.4,Letchuman Vijay3,Chan Andrew K.5,Shabani Saman6,Lavadi Raj Swaroop1,Lu Daniel C.7,Wang Michael Y.8,Haid Regis W.9,Knightly John J.10,Sherrod Brandon A.11,Gottfried Oren N.12,Shaffrey Christopher I.12,Goldberg Jacob L.13,Virk Michael S.13,Hussain Ibrahim13,Glassman Steven D.14,Shaffrey Mark E.15,Park Paul16,Foley Kevin T.16,Pennicooke Brenton17,Coric Domagoj18,Upadhyaya Cheerag19,Potts Eric A.20,Tumialán Luis M.21,Fu Kai-Ming G.13,Asher Anthony L.18,Bisson Erica F.11,Chou Dean5,Bydon Mohamad4,Mummaneni Praveen V.3

Affiliation:

1. Department of Neurological Surgery, University of Pittsburgh School of Medicine

2. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA

3. Department of Neurosurgery, University of California, San Francisco, San Francisco, CA

4. Department of Neurologic Surgery, Mayo Clinic, Rochester, MN

5. Department of Neurosurgery, Columbia University Irving Medical Center, New York City, NY

6. Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, WI

7. Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA

8. Department of Neurological Surgery, University of Miami, Miami, FL

9. Atlanta Brain and Spine Care, Atlanta, GA

10. Atlantic Neurosurgical Specialists, Morristown, NJ

11. Department of Neurosurgery, University of Utah, Salt Lake City, UT

12. Department of Neurosurgery, Duke University, Durham, NC

13. Department of Neurological Surgery, Weill Cornell Medical Center, New York, NY

14. Norton Leatherman Spine Center, Louisville, KY

15. Department of Neurosurgery, University of Virginia, Charlottesville, VA

16. Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee, Memphis, TN

17. Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO

18. Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte

19. Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC

20. Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, IN

21. Department of Neurosurgery, Barrow Neurologic Institute, Phoenix, AZ

Abstract

Study Design: Retrospective review of a prospectively maintained database. Objective: Assess differences in preoperative status and postoperative outcomes among patients of different educational backgrounds undergoing surgical management of cervical spondylotic myelopathy (CSM). Summary of Background Data: Patient education level (EL) has been suggested to correlate with health literacy, disease perception, socioeconomic status (SES), and access to health care. Methods: The CSM data set of the Quality Outcomes Database (QOD) was queried for patients undergoing surgical management of CSM. EL was grouped as high school or below, graduate-level, and postgraduate level. The association of EL with baseline disease severity (per patient-reported outcome measures), symptoms >3 or ≤3 months, and 24-month patient-reported outcome measures were evaluated. Results: Among 1141 patients with CSM, 509 (44.6%) had an EL of high school or below, 471 (41.3%) had a graduate degree, and 161 (14.1%) had obtained postgraduate education. Lower EL was statistically significantly associated with symptom duration of >3 months (odds ratio=1.68), higher arm pain numeric rating scale (NRS) (coefficient=0.5), and higher neck pain NRS (coefficient=0.79). Patients with postgraduate education had statistically significantly lower Neck Disability Index (NDI) scores (coefficient=-7.17), lower arm pain scores (coefficient=−1), and higher quality-adjusted life-years (QALY) scores (coefficient=0.06). Twenty-four months after surgery, patients of lower EL had higher NDI scores, higher pain NRS scores, and lower QALY scores (P<0.05 in all analyses). Conclusions: Among patients undergoing surgical management for CSM, those reporting a lower educational level tended to present with longer symptom duration, more disease-inflicted disability and pain, and lower QALY scores. As such, patients of a lower EL are a potentially vulnerable subpopulation, and their health literacy and access to care should be prioritized.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Orthopedics and Sports Medicine,Surgery

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