Greater Neighborhood Deprivation Is Associated With Increased Lengths of Stay and Medical Complications Following Cervical Disc Arthroplasty: A Nationwide Study.

Abstract

Retrospective case-control study. To evaluate whether patients from highly deprived neighborhoods, as defined by the Area Deprivation Index (ADI), undergoing one-level cervical disc arthroplasty (CDA) experience differences in (1) postoperative medical complications, (2) lengths of stay (LOS), emergency department (ED) visits, and readmissions compared with less disadvantaged patients. The ADI measures neighborhood-level deprivation at the national level. Little is known about the role of neighborhood deprivation on outcomes after CDA. A national insurance claims database was used to identify patients who underwent single-level CDA between 2010 and 2022. Patients from less disadvantaged neighborhoods (ADI <90th percentile) were matched in a 1:5 ratio with patients from more deprived areas (ADI >90th percentile) using propensity score matching on age, sex, and Elixhauser Comorbidity Index (ECI), yielding a final cohort of 25,975 patients: 4331 in the low ADI group and 21,644 in the high ADI group. Multivariable logistic regression models were used to assess odds of 90-day complications, readmissions, and ED visits. t tests compared LOS. P-values<0.05 were significant. High ADI patients experienced significantly higher odds of total 90-day medical complications compared with less disadvantaged patients (3.54% vs. 2.67%; OR: 1.37; 95% CI: 1.12-1.70; P=0.003). High ADI patients had longer mean hospital stays (1.75 vs. 1.66 d; P<0.01). Ninety-day readmission (1.54% vs. 1.36%; OR: 1.13; P=0.379) and ED visits (1.64% vs. 1.43%; OR: 1.14; P=0.330) were similar between groups. Neighborhood deprivation is associated with increased lengths of stay and a higher overall rate of medical complications after CDA, despite similar readmission and ED visit rates. These findings emphasize the importance of incorporating socioeconomic context into perioperative care and resource planning. Level III.