Impact of Educational Background on Preoperative Disease Severity and Postoperative Outcomes Among Patients With Cervical Spondylotic Myelopathy.

dc.contributor.author

Agarwal, Nitin

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DiGiorgio, Anthony

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Michalopoulos, Giorgos D

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Letchuman, Vijay

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Chan, Andrew K

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Shabani, Saman

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Lavadi, Raj Swaroop

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Lu, Daniel C

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Wang, Michael Y

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Haid, Regis W

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Knightly, John J

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Sherrod, Brandon A

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Gottfried, Oren N

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Shaffrey, Christopher I

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Goldberg, Jacob L

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Virk, Michael S

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Hussain, Ibrahim

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Glassman, Steven D

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Shaffrey, Mark E

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Park, Paul

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Foley, Kevin T

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Pennicooke, Brenton

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Coric, Domagoj

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Upadhyaya, Cheerag

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Potts, Eric A

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Tumialán, Luis M

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Fu, Kai-Ming G

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Asher, Anthony L

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Bisson, Erica F

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Chou, Dean

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Bydon, Mohamad

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Mummaneni, Praveen V

dc.date.accessioned

2023-12-22T17:24:18Z

dc.date.available

2023-12-22T17:24:18Z

dc.date.issued

2023-12

dc.description.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.
dc.identifier

01933606-990000000-00240

dc.identifier.issn

2380-0186

dc.identifier.issn

2380-0194

dc.identifier.uri

https://hdl.handle.net/10161/29548

dc.language

eng

dc.publisher

Ovid Technologies (Wolters Kluwer Health)

dc.relation.ispartof

Clinical spine surgery

dc.relation.isversionof

10.1097/bsd.0000000000001557

dc.rights.uri

https://creativecommons.org/licenses/by-nc/4.0

dc.title

Impact of Educational Background on Preoperative Disease Severity and Postoperative Outcomes Among Patients With Cervical Spondylotic Myelopathy.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

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Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

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