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Study Design. Retrospective observational study. Objective. To elucidate racial and socioeconomic factors driving preoperative disparities in spine surgery patients. Summary of Background Data. There are racial and socioeconomic disparities in preoperative health among spine surgery patients, which may influence outcomes for minority and low socioeconomic status (SES) populations.Methods. Presenting, postoperative day 90 (POD90), and 12month (12M) outcome scores (PROMIS global physical and mental [GPH, GMH] and visual analog scale pain [VAS]) were collected for patients undergoing deformity arthrodesis or cervical, thoracic, or lumbar laminotomy or decompression/ fusion; these procedures were the most common in our cohort. Social determinants of health for a patient's neighborhood (county, zip code, or census tract) were extracted from public databases. Multivariable linear regression with stepwise selection was used to quantify the association between a patient's preoperative GPH score and sociodemographic variables.Results. Black patients presented with 1 to 3 point higher VAS pain scores (7-8 vs. 5-6) and lower (worse) GPH scores (6.5-10 vs. 11-12) than White patients (P < 0.05 for all comparisons); similarly, lower SES patients presented with 1.5 points greater pain (P < 0.0001) and 3.5 points lower GPH (P < 0.0001) than high SES patients. Patients with lowest-quartile presenting GPH scores reported 36.8% and 37.5% lower (worse) POD-90 GMH and GPH scores than the highest quartile, respectively (GMH: 12 vs. 19, P < 0.0001; GPH: 15 vs. 24, P < 0.0001); this trend extended to 12 months (GMH: 19.5 vs. 29.5, P < 0.0001; GPH: 22 vs. 30, P < 0.0001). Reduced access to primary care (B ¼ À1.616, P < 0.0001) and low SES (B ¼ -1.504, P ¼ 0.001), proxied by median household value, were independent predictors of worse presenting GPH scores. Conclusion. Racial and socioeconomic disparities in patients' preoperative physical and mental health at presentation for spine surgery are associated adversely with postoperative outcomes. Renewed focus on structural factors influencing preoperative presentation, including timeliness of care, is essential. Key words: access to surgical care, area deprivation index, outcomes in spine surgery, patient reported outcomes in spine surgery, racial disparities, racial disparities in patient reported outcomes, social determinants of health, socioeconomic disparities in spine surgery, timeliness of surgical care.

Background and Objectives We aim to assess the quality and readability of online information available to patients considering cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS‐HIPEC). Methods The top three search engines (Google, Bing, and Yahoo) were searched in March 2022. Websites were classified as academic, hospital‐affiliated, foundation/advocacy, commercial, or unspecified. Quality of information was assessed using the JAMA benchmark criteria (0–4) and DISCERN tool (16–80), and the presence of a Health On the Net code (HONcode) seal. Readability was evaluated using the Flesch Reading Ease score. Results Fifty unique websites were included. The average JAMA and DISCERN scores of all websites were 0.72 ± 1.14 and 39.58 ± 13.71, respectively. Foundation/advocacy websites had significantly higher JAMA mean score than commercial (p = 0.044), academic (p < 0.001), and hospital‐affiliated websites (p = 0.001). Foundation/advocacy sites had a significantly higher DISCERN mean score than hospital‐affiliated (p = 0.035) and academic websites (p = 0.030). The HONcode seal was present in 4 (8%) websites analyzed. Readability was difficult and at the level of college students. Conclusions The overall quality of patient‐oriented online information on CRS‐HIPEC is poor and available resources may not be comprehensible to the general public. Patients seeking information on CRS‐HIPEC should be directed to sites affiliated with foundation/advocacy organizations.

Background As patients seek online health information to supplement their medical decision‐making, the aim of this study is to assess the quality and readability of internet information on the left ventricular assist device (LVAD). Methods Three online search engines (Google, Bing, and Yahoo) were searched for “LVAD” and “Left ventricular assist device.” Included websites were classified as academic, foundation/advocacy, hospital‐affiliated, commercial, or unspecified. The quality of information was assessed using the JAMA benchmark criteria (0–4), DISCERN tool (16–80), and the presence of Health On the Net code (HONcode) accreditation. Readability was assessed using the Flesch Reading Ease score. Results A total of 38 unique websites were included. The average JAMA and DISCERN scores of all websites were 0.82 ± 1.11 and 52.45 ± 13.51, respectively. Academic sites had a significantly lower JAMA mean score than commercial (p < 0.001) and unspecified (p < 0.001) websites, as well as a significantly lower DISCERN, mean score than commercial sites (p = 0.002). HONcode certification was present in 6 (15%) websites analyzed, which had significantly higher JAMA (p < 0.001) and DISCERN (p < 0.016) mean scores than sites without HONcode certification. Readability was fairly difficult and at the level of high school students. Conclusions The quality of online information on the LVAD is variable, and overall readability exceeds the recommended level for the public. Patients accessing online information on the LVAD should be referred to sites with HONcode accreditation. Academic institutions must provide higher quality online patient literature on LVADs.

Shared decision-making is a key component of patient-centered care. In this clinical vignette, we illustrate the value of bringing patients into the clinical thought process as part of shared decision-making.

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