P68. Racial Disparities in Presenting Physical Functionality and Mental Distress Characteristics of Patients Undergoing Spine Surgery

BACKGROUND CONTEXT When considering severity of presentation, patient-reported outcomes (PROs) have become increasingly emphasized in orthopedic surgery as surrogates for quality of care. Additionally, PROs provide insight into the severity of an illness or injury and its impact on a patient's life and may also be predictors of treatment outcomes and patient satisfaction. The literature suggests that Black and other minority patients undergoing spine surgery are more likely to present with lower baseline PROs (bodily pain, physical functioning), worse symptom severity, and greater pain compared to white patients. PURPOSE To examine racial disparities in functional and mental health impairment, measured by PROMIS scores for mental health and physical impairment, upon indication for spine surgery. STUDY DESIGN/SETTING Retrospective Chart Review of patient reported scores on presentation for spinal surgery. PATIENT SAMPLE Patients between November 2018 and August 2019 who received 1-2 segment cervical decompression and fusion, 1-2 segment cervical or thoracic laminotomy, 1-2 segment lumbar laminotomy, 1-2 level lumbar interbody fusion, or arthrodesis to correct long, spinal deformity but limited to 8 segments or fewer. OUTCOME MEASURES Patient-Reported Outcome Measurement Information System (PROMIS) Global Physical Health (GPH) score, a PROMIS Global Mental Health (GPH) score, and a Visual Analog Scale (VAS) pain score at the time of presentation. METHODS Chi Square analysis, one-way analysis of variance (ANOVA), and Kruskal-Wallis analyses were used to determine if race, socioeconomic status of a patient's community, and procedure type had an effect on the degree of physical impairment, overall pain, or mental distress of a presenting patient. Bonferroni-corrected post hoc t tests and Dunn's post hoc nonparametric test for multiple comparisons were conducted after obtaining significant ANOVA, or Kruskal-Wallis results, respectively. RESULTS The overall study sample predominantly self-identified as racially White (73.5%), and males comprised 49.8% of the total cohort. At the time of presentation for spine surgery, patients presented with an average Visual Analog Scale (VAS) pain score of 5.84 (95% C.I: 5.66-6.03), a median PROMIS mental health score of 12 (IQR: 9-15), and a median PROMIS physical health score of 11 (IQR: 8-13). Notably, there was no difference in the presenting pain score by the Visual Analog Scale among patients who underwent the five different procedures (PANOVA = 0.9749) When compared to White patients undergoing the same procedure, Black/African-American patients had median VAS pain scores that were 16.7% higher, indicating greater pain, among those undergoing cervical decompression and fusion (P= 0.047) as well as lumbar interbody fusion (P=0.0167). Black/African-American patients had median VAS pain scores that were 60% higher among those undergoing cervical/thoracic laminotomy (P=0.0005), lumbar laminotomy (P<0.0001), and arthrodesis for spinal deformity (P=0.0012) when compared to White patients undergoing the same procedure. Additionally, Black/African-American patients had lower median PROMIS mental scores among those undergoing cervical/thoracic laminotomy (P=0.0012), lumbar laminotomy (P=0.0195), and lumbar interbody fusion (P=0.0208). Black/African-American patients had lower median PROMIS physical scores among those undergoing cervical decompression and fusion (P=0.0028), cervical or thoracic laminotomy (P=0.0024), lumbar laminotomy (P<0.0001), lumbar interbody fusion (P=0.0100), and arthrodesis to correct long, spinal deformity (P=0.0261). CONCLUSIONS These findings suggest that racial disparities exist in patients’ presentation for spine surgery. Likely causes include disparities in household income, characteristics of a patient's neighborhood, and a patient's access to health care. Our findings refute any notions or misconceptions held by both medical professionals and laypersons that Black/African-American patients are more immune to pain and impairment when compared to White patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. When considering severity of presentation, patient-reported outcomes (PROs) have become increasingly emphasized in orthopedic surgery as surrogates for quality of care. Additionally, PROs provide insight into the severity of an illness or injury and its impact on a patient's life and may also be predictors of treatment outcomes and patient satisfaction. The literature suggests that Black and other minority patients undergoing spine surgery are more likely to present with lower baseline PROs (bodily pain, physical functioning), worse symptom severity, and greater pain compared to white patients. To examine racial disparities in functional and mental health impairment, measured by PROMIS scores for mental health and physical impairment, upon indication for spine surgery. Retrospective Chart Review of patient reported scores on presentation for spinal surgery. Patients between November 2018 and August 2019 who received 1-2 segment cervical decompression and fusion, 1-2 segment cervical or thoracic laminotomy, 1-2 segment lumbar laminotomy, 1-2 level lumbar interbody fusion, or arthrodesis to correct long, spinal deformity but limited to 8 segments or fewer. Patient-Reported Outcome Measurement Information System (PROMIS) Global Physical Health (GPH) score, a PROMIS Global Mental Health (GPH) score, and a Visual Analog Scale (VAS) pain score at the time of presentation. Chi Square analysis, one-way analysis of variance (ANOVA), and Kruskal-Wallis analyses were used to determine if race, socioeconomic status of a patient's community, and procedure type had an effect on the degree of physical impairment, overall pain, or mental distress of a presenting patient. Bonferroni-corrected post hoc t tests and Dunn's post hoc nonparametric test for multiple comparisons were conducted after obtaining significant ANOVA, or Kruskal-Wallis results, respectively. The overall study sample predominantly self-identified as racially White (73.5%), and males comprised 49.8% of the total cohort. At the time of presentation for spine surgery, patients presented with an average Visual Analog Scale (VAS) pain score of 5.84 (95% C.I: 5.66-6.03), a median PROMIS mental health score of 12 (IQR: 9-15), and a median PROMIS physical health score of 11 (IQR: 8-13). Notably, there was no difference in the presenting pain score by the Visual Analog Scale among patients who underwent the five different procedures (PANOVA = 0.9749) When compared to White patients undergoing the same procedure, Black/African-American patients had median VAS pain scores that were 16.7% higher, indicating greater pain, among those undergoing cervical decompression and fusion (P= 0.047) as well as lumbar interbody fusion (P=0.0167). Black/African-American patients had median VAS pain scores that were 60% higher among those undergoing cervical/thoracic laminotomy (P=0.0005), lumbar laminotomy (P<0.0001), and arthrodesis for spinal deformity (P=0.0012) when compared to White patients undergoing the same procedure. Additionally, Black/African-American patients had lower median PROMIS mental scores among those undergoing cervical/thoracic laminotomy (P=0.0012), lumbar laminotomy (P=0.0195), and lumbar interbody fusion (P=0.0208). Black/African-American patients had lower median PROMIS physical scores among those undergoing cervical decompression and fusion (P=0.0028), cervical or thoracic laminotomy (P=0.0024), lumbar laminotomy (P<0.0001), lumbar interbody fusion (P=0.0100), and arthrodesis to correct long, spinal deformity (P=0.0261). These findings suggest that racial disparities exist in patients’ presentation for spine surgery. Likely causes include disparities in household income, characteristics of a patient's neighborhood, and a patient's access to health care. Our findings refute any notions or misconceptions held by both medical professionals and laypersons that Black/African-American patients are more immune to pain and impairment when compared to White patients.