172 Does the Number of Social Risk Factors Affect Long-term Patient-Reported Outcomes and Satisfaction in Those With Cervical Myelopathy? A QOD Study

INTRODUCTION: It is not clear whether there is an additive effect of social risk factors in affecting patients with cervical spondylotic myelopathy (CSM) from achieving both a minimum clinically important difference (MCID) in outcomes and satisfaction after surgery. METHODS: This was a retrospective study of the prospective Quality Outcomes Database Cervical Spondylotic Myelopathy (QOD CSM) cohort. Social risk factors included race, education, employment, and insurance. Patients were considered to have improved from surgery if 1) they reported a score of 1 or 2 on the NASS index and 2) met the MCID in patient-reported outcomes (VAS neck and arm pain, NDI, EQ5D, or mJOA score) at 24-month follow-up. RESULTS: Of the 1,141 patients included in the study, 205 (18.0%) had zero, 347 (30.4%) had one, 334 (29.3%) had two, and 255 (22.3%) had three social risk factors. The 24-month follow-up rate was 87.4% for patient-reported outcomes. After adjusting for all significant covariates, patients with one or more social risk factors were less likely to improve from surgery in all measured outcomes including VAS neck and arm pain, NDI, EQ-5D, and mJOA (all p < 0.05) compared to those without any social risk factors. Patients with two or three social risk factors were more likely to fare worse in all outcomes compared to those with only one social risk factor (all p < 0.05). CONCLUSIONS: Compared to those without any social risk factors, patients who had at least one social risk factor were less likely to achieve MCID and feel satisfied after surgery. The effect of social risk factors is additive in that those with a higher number of risk factors are less likely to improve compared to those with only one social risk factor.