학술논문
Impact of Educational Background on Preoperative Disease Severity and Postoperative Outcomes Among Patients With Cervical Spondylotic Myelopathy
Document Type
Academic Journal
Author
Agarwal, Nitin; DiGiorgio, Anthony; Michalopoulos, Giorgos D.; Letchuman, Vijay; Chan, Andrew K.; Shabani, Saman; Lavadi, Raj Swaroop; Lu, Daniel C.; Wang, Michael Y.; Haid, Regis W.; Knightly, John J.; Sherrod, Brandon A.; Gottfried, Oren N.; Shaffrey, Christopher I.; Goldberg, Jacob L.; Virk, Michael S.; Hussain, Ibrahim; Glassman, Steven D.; Shaffrey, Mark E.; Park, Paul; Foley, Kevin T.; Pennicooke, Brenton; Coric, Domagoj; Upadhyaya, Cheerag; Potts, Eric A.; Tumialán, Luis M.; Fu, Kai-Ming G.; Asher, Anthony L.; Bisson, Erica F.; Chou, Dean; Bydon, Mohamad; Mummaneni, Praveen V.
Source
Clinical Spine Surgery. Apr 01, 2024 37(3):E137-E146
Subject
Language
English
ISSN
2380-0186
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.