Demographic and Socioeconomic Association with Surgical Recommendations in Multidisciplinary Adult Spinal Deformity Conference.

Abstract

Surgical treatment for adult spinal deformity (ASD) is associated with high rates of perioperative complications and mortality. To address these complexities, multidisciplinary approaches have emerged as a promising strategy to optimize patient care, enhance surgical outcomes, and mitigate complications. This study examines whether a multidisciplinary conference at a quaternary referral center discriminates based on socioeconomic disparities measured by the Area Deprivation Index (ADI). Single-center retrospective review. 698 patients evaluated in a multidisciplinary conference between August 2015 and March 2025. The primary outcome was the recommendation for surgery following multidisciplinary conference discussion. ADI scores were compared between patients who were recommended for surgery and those who were not. Secondly outcomes were demographic data, clinical outcomes, comorbidity index (CCI), and socioeconomic factors among these two groups. Participants were categorized to surgery group (n = 398) and non-surgery group (n = 300). On univariate analysis, patients recommended for surgery were more likely to be White (80.7% vs. 65.3%, p < .001), non-Hispanic (88.4% vs. 73.3%, p < .001), and had greater distance to the hospital (146.7 vs. 91.7 miles, p = .01). In the multivariate model, non-Hispanic ethnicity (OR 2.58, 95% CI 1.69-3.99) and White race (OR 1.60, 95% CI 1.09-2.33) were independently associated with higher odds of surgical recommendation. Other factors, including insurance type, CCI, ADI, and distance to hospital, were not significant predictors in the multivariate model. This study identified that surgical recommendations in a multidisciplinary spine clinic were not associated with socioeconomic factor. Our findings highlight the importance of future efforts on developing strategies to identify and mitigate these persistent individual-level biases.