P84. Socioeconomic barriers to patient-reported outcome measure completion following lumbar spine fusion

BACKGROUND CONTEXT Although incorporating patient reported outcomes (PROMs) into practice allows health care systems to evaluate the value of care provided, research, and policy reflecting PROMs can only be valid if they represent all patients. Few studies have evaluated socioeconomic barriers to follow-up PROM completion, and none have done so in a spine patient population. Understanding the barriers to PROM completion in spine surgery may help health care providers identify patients who may benefit from closer follow-up and targeted interventions. PURPOSE To identify patient barriers to PROM completion one year following lumbar spine fusion. STUDY DESIGN/SETTING Retrospective single-institution cohort study. PATIENT SAMPLE A total of 2,984 patients undergoing lumbar fusion between 2014-2020. OUTCOME MEASURES Completion of Mental Component Score (MCS-12) and Physical Component Score (PCS-12) of Short Form-12 questionnaire one year postoperatively. METHODS A retrospective review was conducted of all patients undergoing 1-3-level lumbar fusion at a single urban tertiary center. Patient health status, demographics, and social health questions were collected from preoperative questionnaires. PROMs were queried from our prospectively managed electronic outcomes database which was established in 2012. Patients were considered to have complete PROMs if one-year outcomes were available. Community-level characteristics were collected from patients’ zip codes using the Economic Innovation Group Distressed Communities Index. Bivariate analyses were performed to assess factors associated with PROM incompletion along with multivariate logistic regression to control for confounders. RESULTS A total of 1,968 (66.0%) had incomplete one-year PROMs. Patients with incomplete PROMs were more likely to be Black (14.5% vs 9.3%, p<0.001), Hispanic (2.9% vs 1.6%, p=0.027), reside in a distressed community (14.7% vs 8.5%, p<0.001), and be active smokers (22.4% vs 15.5%, p0.05). On multivariate regression, Black race (OR: 1.49, p<0.01), Hispanic ethnicity (OR: 2.23, p=0.024), distressed community status (OR: 1.46, p=0.026), and active smoking (OR:1.38, p=0.013) all were independently associated with PROM incompletion. Non-Black minorities were not less likely to have complete PROMs (OR: 0.91, p=0.632). Surgical characteristics, including primary surgeon, revision status, approach, and levels fused were not associated with PROM incompletion. CONCLUSIONS Our work suggests that ethnic and racial minorities and those of lower SES face significant barriers to patient-reported outcome completion after lumbar spine fusion. Patients completing PROMs are overwhelmingly White, non-Hispanic, and reside in wealthier communities. Efforts should be taken to provide better education regarding PROMs and ensure closer followup of certain subgroups of patients to avoid furthering disparities in PROM research. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Although incorporating patient reported outcomes (PROMs) into practice allows health care systems to evaluate the value of care provided, research, and policy reflecting PROMs can only be valid if they represent all patients. Few studies have evaluated socioeconomic barriers to follow-up PROM completion, and none have done so in a spine patient population. Understanding the barriers to PROM completion in spine surgery may help health care providers identify patients who may benefit from closer follow-up and targeted interventions. To identify patient barriers to PROM completion one year following lumbar spine fusion. Retrospective single-institution cohort study. A total of 2,984 patients undergoing lumbar fusion between 2014-2020. Completion of Mental Component Score (MCS-12) and Physical Component Score (PCS-12) of Short Form-12 questionnaire one year postoperatively. A retrospective review was conducted of all patients undergoing 1-3-level lumbar fusion at a single urban tertiary center. Patient health status, demographics, and social health questions were collected from preoperative questionnaires. PROMs were queried from our prospectively managed electronic outcomes database which was established in 2012. Patients were considered to have complete PROMs if one-year outcomes were available. Community-level characteristics were collected from patients’ zip codes using the Economic Innovation Group Distressed Communities Index. Bivariate analyses were performed to assess factors associated with PROM incompletion along with multivariate logistic regression to control for confounders. A total of 1,968 (66.0%) had incomplete one-year PROMs. Patients with incomplete PROMs were more likely to be Black (14.5% vs 9.3%, p<0.001), Hispanic (2.9% vs 1.6%, p=0.027), reside in a distressed community (14.7% vs 8.5%, p<0.001), and be active smokers (22.4% vs 15.5%, p0.05). On multivariate regression, Black race (OR: 1.49, p<0.01), Hispanic ethnicity (OR: 2.23, p=0.024), distressed community status (OR: 1.46, p=0.026), and active smoking (OR:1.38, p=0.013) all were independently associated with PROM incompletion. Non-Black minorities were not less likely to have complete PROMs (OR: 0.91, p=0.632). Surgical characteristics, including primary surgeon, revision status, approach, and levels fused were not associated with PROM incompletion. Our work suggests that ethnic and racial minorities and those of lower SES face significant barriers to patient-reported outcome completion after lumbar spine fusion. Patients completing PROMs are overwhelmingly White, non-Hispanic, and reside in wealthier communities. Efforts should be taken to provide better education regarding PROMs and ensure closer followup of certain subgroups of patients to avoid furthering disparities in PROM research.