Socially vulnerable patients may have increased opioid use, ED visits after spine surgery
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CHICAGO — Results presented at the North American Spine Society Annual Meeting showed patients who were socially vulnerable were more likely to have persistent opioid use and increased ED visits 6 months after elective spine surgery.
Erik B. Gerlach, MD, and colleagues determined Cook County Social Vulnerability Index (SVI) metrics based on the ZIP code of patients’ home neighborhood for 92 patients who underwent elective spine surgery for lumbar degenerative pathology between 2013 and 2018.
“The SVIs comprised of separate scores pertaining to socioeconomic status, household compensation, minority status and language, and housing type and transportation,” Gerlach said in his presentation here. “Possible scores ranged from 0, the lowest vulnerability, to 1, the highest vulnerability.”
Patients were categorized into two groups: patients with social vulnerability with an SVI score greater than or equal to 0.75 and control patients with an SVI score of less than 0.75, according to Gerlach. Researchers assessed baseline patient demographics, underlying comorbidities and preoperative opioid use as potential risk factors and compared health care resource utilization metrics within 1 year postoperatively between the two groups.
“The health care utilization metrics that were examined in the postoperative setting are listed here, consisting of spinal radiographs; advanced imaging, such as CT and MRIs; emergency department; urgent care and postoperative clinic visits; the total number of opiate prescriptions postoperatively; pain management referrals; and epidural or other spinal injections,” Gerlach said.
Results showed 35.9% of patients were socially vulnerable based on their SVI metrics. Compared with controls, Gerlach noted patients who were socially vulnerable were more likely to utilize the ED within 180 and 365 days postoperatively. He added patients who were socially vulnerable were three times more likely to have persistent opioid use at 180 days postoperatively. Linear regression analysis suggested an association between an overall SVI in the upper quartiles and persistent opioid use and at least one ED visit within 180 days postoperatively.
“We found that patients who are socially vulnerable were not more likely to have higher rates of health care utilization in the first year after surgery when it comes to the following resources, such as X-rays, CTs, MRI imaging studies, postoperative clinic visits, urgent care visits, pain management referrals and epidural or other spinal injections,” Gerlach said.
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Gerlach EB, et al. paper 154. Presented at: North American Spine Society Annual Meeting; Oct. 12-15, 2022; Chicago.
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