Social determinants of health independently shape how spine surgery patients present, recover and use postoperative care, according to an invited review in the September/October 2026 issue of SpineLine, the North American Spine Society’s member magazine.
Vahe Yacoubian, MD, of Loma Linda (Calif.) University Medical Center; Adelin Tulcan of Loma Linda University School of Medicine; and Olumide Danisa, MD, of Duke University Medical Center in Durham, N.C., wrote the review.
The literature ties socioeconomic disadvantage to worse baseline disability, more complications, longer hospital stays, more discharges to skilled nursing facilities and higher readmission or emergency department use. Those links were held after researchers adjusted for age, comorbidities and surgical complexity.
The authors assessed four area-level indices that link a patient’s home address to census and economic data: the CDC’s Social Vulnerability Index, which draws on 16 census variables; the Area Deprivation Index, built on 17; and the Distressed Communities Index and Social Deprivation Index, which use seven indicators each. The SVI offers the broadest view because it captures household structure and transportation access, the authors concluded.
They cautioned that social vulnerability should not mark a patient as a poor surgical candidate. Instead, flagging high-risk patients in the EHR can trigger early care coordination, social work involvement, discharge planning and tailored education. The authors also noted that area-level indices can misclassify individual risk and should complement clinical judgment, not replace it.
The authors called for further research into how bundled payments, post-acute network design and quality metrics can avoid penalizing hospitals and surgeons that care for vulnerable communities.
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