Introduction: Early postoperative rehabilitation through physical therapy (PT) is linked to better outcomes in spine surgery patients. PT utilization varies, potentially driven by access limitations related to socioeconomic status (SES) and social determinants of health (SDH). This study examines how low SES and economic SDH affect PT utilization and timing in patients undergoing elective lumbar spine surgery.
Methods: The IBM Watson Health MarketScan claims database and Medicare Supplement were queried for adults undergoing elective lumbar spine surgery between 2006 and 2023, with a minimum of six months postoperative follow-up. SES was assessed using county-level area deprivation index (ADI) centile, while economic SDH factors included employment status, hourly vs. salary work, manual vs. non-manual labor, and mean income. The primary outcome was postoperative PT utilization. Secondary outcomes included the total number of PT sessions and the time until the first session. Multivariate regression models evaluated the effects of SES and SDH on these outcomes.
Results: Of the total 148,186 lumbar spine surgery patients included, 53.7% attended at least one postoperative PT session. Multivariate regression indicated that retirees (vs active full/part-time workers, odds ratio [OR]:1.39, 95% confidence interval [CI]:1.33-1.45), hourly workers (OR=1.68, [1.53-1.82]), those with low mean income (OR=1.12, [1.04-1.20]), and patients in the most deprived ADI centiles (OR=1.11, [0.94-1.31]) had significantly higher odds of not receiving postoperative PT. Among those who did receive postoperative PT, Medicare-eligible patients (vs active full/part-time workers, B-coefficient= -1.38, [- 2.15, -0.61]), hourly workers (B-coefficient= - 1.08, [1.70, -0.45]), low-income patients (B-coefficient= 4.06, [-4.61, -3.51]) and those with high ADI (B-coefficient= -2.72, [-4.07, -1.38]) had a lower overall number PT sessions. Time-to-event analyses revealed that manual laborers (hazard ratio [HR]:0.97, [0.92-0.97]) and low-income earners (HR=0.97, [0.91-1.02]) had a longer wait time for PT initiation.
Conclusion : Lower SES and economic SDH may negatively affect access to postoperative PT for elective lumbar and cervical spine surgery patients. Addressing disparities in PT access may enhance operative outcomes for these patients.
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