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The impact of social determinants of health on early outcomes after adult Chiari surgery

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Abstract

We sought to identify social determinants of health (SDoH) for adult patients undergoing Chiari decompression surgery and to analyze their association with postoperative outcomes, including length of stay (LOS), return to the system within 30 days, and the Chicago Chiari Outcomes Score (CCOS). This is a retrospective study of adult patients who underwent Chiari decompression surgery between June 2021 and January 2023. Data was gathered through electronic medical record review and telephone surveys. Descriptive statistics were used to evaluate demographics of all patients meeting inclusion criteria. Fisher’s exact tests and logistic regression were used for data analysis. A total of 37 patients underwent Chiari decompression (23 CCOS/SDoH survey respondents): 48% bony decompression only, 30% bony decompression plus intradural exploration, and 22% occipitocervical fusion. Seven patients (30%) had a LOS > 2 days, 1 patient (4%) required inpatient rehabilitation postoperatively, 4 patients (17%) returned to the system within 30 days, 10 patients (43%) had an extremely favorable CCOS (15–16), and 11 patients (48%) reported interaction with a Chiari support group. Mean follow-up was 9.5 months. Patients with occipitocervical fusion were more likely to have a LOS > 2 days (p = 0.03), patients who exercised ≥ 3 days per week were more likely to have a favorable CCOS (p = 0.04), and patients who participated in a Chiari support group were less likely to have a favorable CCOS (p = 0.03). Chiari decompression plus occipitocervical fusion may be associated with increased LOS. While more frequent exercise may be associated with better post-surgical outcomes, participation in a Chiari support group may be correlated with worse outcomes.

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Abbreviations

SDoH:

Social determinants of health

LOS:

Length of stay

CCOS:

Chicago Chiari Outcomes Score

WHO:

World Health Organization

IRB:

Institutional Review Board

IDeA:

Institutional Development Award

NIGMS:

National Institute of General Medical Sciences

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Acknowledgements

Dr. Sixia Chen was supported by the Oklahoma Shared Clinical and Translational Resources (U54GM104938) with an Institutional Development Award (IDeA) from NIGMS. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding

Oklahoma Shared Clinical and Translational Resources (U54GM104938) with an Institutional Development Award (IDeA) from NIGMS.

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Authors and Affiliations

  1. Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Sherwin Tavakol, Kristin Zieles, Mikayla Peters, Michael Omini & Andrew Jea

  2. Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Sixia Chen

Authors
  1. Sherwin Tavakol
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  2. Kristin Zieles
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  3. Mikayla Peters
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  4. Michael Omini
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  5. Sixia Chen
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  6. Andrew Jea
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Contributions

Material preparation and analysis were performed by ST, AJ, and SC. Data collection was performed by ST, KZ, MP, and MO. The first draft of the manuscript was written by ST and AJ, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sherwin Tavakol.

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Tavakol, S., Zieles, K., Peters, M. et al. The impact of social determinants of health on early outcomes after adult Chiari surgery. GeroScience 46, 1451–1459 (2024). https://doi.org/10.1007/s11357-023-01021-y

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  • DOI: https://doi.org/10.1007/s11357-023-01021-y

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