A Tale of 2 Institutions: Differences in Sociodemographic Factors, Presenting Features, Treatment Characteristics, and Outcomes in Patients Undergoing Surgery for Spinal Metastases.

Abstract

The objective of this study was to compare sociodemographic factors, presenting characteristics, and outcomes between cohorts of patients receiving surgery for spinal metastases at 2 neighboring institutions, 1 private and 1 public, affiliated with a single major academic medical center in a large metropolitan area. This analysis included all patients who underwent decompressive surgery for extradural spinal metastases. Sociodemographic factors, treatment characteristics, and outcomes were compared between those treated at a private hospital and a neighboring public hospital using Rao-Scott χ2 tests for categorical variables, Student t tests for continuous variables, and the Kaplan-Meier product-limit method for overall survival and progression-free survival. Compared with those treated at our private hospital, patients treated at our public hospital were more often younger (P = .005), of Black or Hispanic race (72.6% vs 19%, P < .001), and uninsured (16% vs 5.6%, P = .005). They more frequently presented with epidural spinal cord compression grade 3 (76% vs 56.8%, P = .027), were nonambulatory before surgery (56.9% vs 13.5%, P < .001), and had increased neurological impairment as denoted by American Spinal Injury Association Impairment Scale grades of A, B, or C (39.2% vs 7.5%). Patients treated at our public hospital had shorter median follow-up time (92 vs 302.5 days, P = .004). Multivariate analysis did not reveal a significant difference in overall survival or progression-free survival between hospitals, instead demonstrating associations with primary tumor histology and number of spinal metastases (P < .05). There were substantial disparities in sociodemographic factors, presenting local disease burden, and postoperative neurological outcome but no difference in survival outcome, between patients treated at our public and private hospitals. These findings underscore the need for more equitable screening, surveillance, and referral structures.