Impact of Educational Background on Preoperative Disease Severity and Postoperative Outcomes Among Patients With Cervical Spondylotic Myelopathy.
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2023-12
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Abstract
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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.Type
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Agarwal, Nitin, Anthony DiGiorgio, Giorgos D Michalopoulos, Vijay Letchuman, Andrew K Chan, Saman Shabani, Raj Swaroop Lavadi, Daniel C Lu, et al. (2023). Impact of Educational Background on Preoperative Disease Severity and Postoperative Outcomes Among Patients With Cervical Spondylotic Myelopathy. Clinical spine surgery. 10.1097/bsd.0000000000001557 Retrieved from https://hdl.handle.net/10161/29548.
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Oren N Gottfried
I specialize in the surgical management of all complex cervical, thoracic, lumbar, or sacral spinal diseases by using minimally invasive as well as standard approaches for arthritis or degenerative disease, deformity, tumors, and trauma. I have a special interest in the treatment of thoracolumbar deformities, occipital-cervical problems, and in helping patients with complex spinal issues from previously unsuccessful surgery or recurrent disease.I listen to my patients to understand their symptoms and experiences so I can provide them with the information and education they need to manage their disease. I make sure my patients understand their treatment options, and what will work best for their individual condition. I treat all my patients with care and concern – just as I would treat my family. I am available to address my patients' concerns before and after surgery. I aim to improve surgical outcomes for my patients and care of all spine patients with active research evaluating clinical and radiological results after spine surgery with multiple prospective databases. I am particularly interested in prevention of spinal deformity, infections, complications, and recurrent spinal disease. Also, I study whether patient specific variables including pelvic/sacral anatomy and sagittal spinal balance predict complications from spine surgery.
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