488 Prospective Evaluation of Racial Disparities in Surgical Treatment Of Degenerative Spondylolisthesis Using PROMIS Pain Interference And Physical Function Scores

Abstract

INTRODUCTION: Spine surgery for degenerative spondylolisthesis is indicated in patients who remain symptomatic despite a course of nonsurgical therapy. Patient’s report of pain interference and physical function are key indicators for intervention. We know that Black and indigenous patients of color have poorer outcomes in back pain. This study aims to identify trends in intervention for degenerative spondylolisthesis based on race and patient-reported outcomes. METHODS: A prospective cohort study of degenerative spondylolisthesis patients seen in Harvard Medical School-affiliated clinics from 2015 to 2022 and who completed the routinely collected PROMIS patient-reported outcome measures (PROMs): Physical Function (PF) and pain Interference (PI). PROMIS scores are standardized to the U.S. population (mean score = 50). Regression analyses were performed to determine factors associated with treatment assignment. RESULTS: In this study, 22 374 patients (mean Age, 66.91(14.22); Female, 64%; BIPOC, 3019 (13%)) completed PROMs at baseline. Medicaid coverage was more prevalent among BIPOC (13% vs. 3.1%; P < 0.001) who were less likely to receive an interventional treatment (351/ 3,019 (12%) vs. 3,021 / 19,355 (16%); P < 0.001) despite a significantly higher pain interference score (62.32 (8.37) vs. 61.51 (8.35); P < 0.001). White race was associated with higher odds of receiving surgical treatment than BIPOC after adjusting for age, comorbidities, medical coverage, physical function, and pain interference at baseline (OR = 1.20; 95 CI, 1.15-1.26; P < 0.001). CONCLUSIONS: Despite higher pain interference scores, BIPOC patients were less likely to be offered spine surgery for degenerative spondylolisthesis, indicating that race is a predictor of spine surgery after accounting for comorbidities, physical function, and disability at diagnosis.