154. Social Vulnerability Index (SVI) can be used to predict health care resource utilization and persistent opioid use after elective lumbar spine surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> The national capacity for health care expenditures is nearing its limit, having experienced recent exponential growth nearing a total of 17% of US GDP. As with all other finite resources, the question of efficient utilization becomes essential. This is especially apparent in subsets of medicine, such as spine surgery, that are significantly more costly. Exploration of patient-specific traits and how they relate to health care resource utilization has become as essential to the practice of medicine as patient outcomes. <h3>PURPOSE</h3> The purpose of this study is to investigate the association between social determinants of health and healthcare resource utilization following elective lumbar spine surgery. <h3>METHODS</h3> Patients who underwent elective spine surgery for lumbar degenerative pathology between November 1, 2013 and September 30, 2018, at a single academic center were retrospectively identified. The Cook County Social Vulnerability Index (SVI) metrics for each patient were determined based on the ZIP code of their home neighborhood. The SVI is comprised of separate scores pertaining to socioeconomic status, household compensation, minority status & language, and housing & transportation. Possible scores range from 0 (lowest vulnerability) to 1 (highest vulnerability). Health resource utilization was quantified within one year postoperatively (imaging studies, emergency and urgent care visits, opioid prescriptions and others). These metrics were compared between patients with social vulnerability – defined as a SVI score in the upper quartile (SVI=0.75) and control patients (SVI score < 0.75). <h3>RESULTS</h3> A total of 92 patients were included in the final cohort. Of these, 33 (35.9%) were considered socially vulnerable based on their SVI metrics. Socially vulnerable patients were more likely to utilize the emergency department within 180 (0.5 ± 1.1 vs 0.1 ± 0.4; p=0.028) and 365 (0.7 ± 1.7 vs 0.2 ± 0.7; p=0.045) days postoperatively. Socially vulnerable patients were more than 3 times more likely to have persistent opioid use at 180 days postoperatively to controls (36.3% vs 11.9%; p=0.005). An overall SVI in the upper quartile was associated with persistent opioid use (OR 4.245; 95% CI: 1.469 – 12.265) and at least one emergency department visit within 180 days postoperatively (OR 4.050; 95% CI: 1.227 – 13.370). <h3>CONCLUSIONS</h3> The SVI was associated with postoperative opioid use and emergency department utilization after surgery. Socially vulnerable patients were more likely to utilize emergency department services and to have persistent opioid use at 6 months postoperatively from elective lumbar spine surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.