P68. Racial disparities in presenting physical functionality and mental distress characteristics of patients undergoing spine surgery

Study Design: Retrospective cohort study. Objectives: Racial disparities in postoperative outcomes are unfortunately common. We present data assessing race as an independent risk factor for postoperative complications after spine surgery for Native American (NA) and African American (AA) patients compared with Caucasians (CA). Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for spine procedures performed in 2015. Data was subdivided by surgery, demography, comorbidity, and 30-day postoperative outcomes, which were then compared by race. Regression was performed holding race as an independent risk factor. Results: A total of 4803 patients (4106 CA, 522 AA, 175 NA) were included in this analysis. AA patients experienced longer length of stay (LOS) and operative times ( P < .001) excluding lumbar fusion, which was significantly shorter ( P = .035). AA patients demonstrated higher comorbidity burden, specifically for diabetes and hypertension ( P < .005), while NA individuals were higher tobacco consumers ( P < .001). AA race was an independent risk factor associated with longer LOS across all cervical surgeries (β = 1.54, P <.001), lumbar fusion (β = 0.77, P = .009), and decompression laminectomy (β = 1.23, P < .001), longer operative time in cervical fusion (β = 12.21, P = .032), lumbar fusion (β = -24.00, P = .016), and decompression laminectomy (OR = 20.95, P < .001), greater risk for deep vein thrombosis in lumbar fusion (OR = 3.72, P = .017), and increased superficial surgical site infections (OR = 5.22, P = .001) and pulmonary embolism (OR = 5.76, P = .048) in decompression laminectomy. NA race was an independent risk factor for superficial surgical site infections following cervical fusion (OR = 14.58, P = .044) and decompression laminectomy (OR = 4.80, P = .021). Conclusion: AA and NA spine surgery patients exhibit disproportionate comorbidity burden and greater 30-day complications compared with CA patients. AA and NA race were found to independently affect rates of complications, LOS, and operation time.

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Influence of racial disparities on patient-reported satisfaction and short- and long-term perception of health status after elective lumbar spine surgery

Journal of Neurosurgery Spine ◽

10.3171/2017.12.spine171079 ◽

2018 ◽

Vol 29 (1) ◽

pp. 40-45 ◽

Cited By ~ 8

Author(s):

Aladine A. Elsamadicy ◽

Hanna Kemeny ◽

Owoicho Adogwa ◽

Eric W. Sankey ◽

C. Rory Goodwin ◽

...

Keyword(s):

Patient Satisfaction ◽

Lumbar Spine ◽

Racial Disparities ◽

Spine Surgery ◽

Lumbar Spine Surgery ◽

Readmission Rates ◽

Patient Reported ◽

Short And Long Term ◽

Satisfaction Measures

OBJECTIVEIn spine surgery, racial disparities have been shown to impact various aspects of surgical care. Previous studies have associated racial disparities with inferior surgical outcomes, including increased complication and 30-day readmission rates after spine surgery. Recently, patient-reported outcomes (PROs) and satisfaction measures have been proxies for overall quality of care and hospital reimbursements. However, the influence that racial disparities have on short- and long-term PROs and patient satisfaction after spine surgery is relatively unknown. The aim of this study was to investigate the impact of racial disparities on 3- and 12-month PROs and patient satisfaction after elective lumbar spine surgery.METHODSThis study was designed as a retrospective analysis of a prospectively maintained database. The medical records of adult (age ≥ 18 years) patients who had undergone elective lumbar spine surgery for spondylolisthesis (grade 1), disc herniation, or stenosis at a major academic institution were included in this study. Patient demographics, comorbidities, postoperative complications, and 30-day readmission rates were collected. Patients had prospectively collected outcome and satisfaction measures. Patient-reported outcome instruments—Oswestry Disability Index (ODI), visual analog scale for back pain (VAS-BP), and VAS for leg pain (VAS-LP)—were completed before surgery and at 3 and 12 months after surgery, as were patient satisfaction measures.RESULTSThe authors identified 345 medical records for 53 (15.4%) African American (AA) patients and 292 (84.6%) white patients. Baseline patient demographics and comorbidities were similar between the two cohorts, with AA patients having a greater body mass index (33.1 ± 6.6 vs 30.2 ± 6.4 kg/m2, p = 0.005) and a higher prevalence of diabetes (35.9% vs 16.1%, p = 0.0008). Surgical indications, operative variables, and postoperative variables were similar between the cohorts. Baseline and follow-up PRO measures were worse in the AA cohort, with patients having a greater baseline ODI (p < 0.0001), VAS-BP score (p = 0.0002), and VAS-LP score (p = 0.0007). However, mean changes from baseline to 3- and 12-month PROs were similar between the cohorts for all measures except the 3-month VAS-BP score (p = 0.046). Patient-reported satisfaction measures at 3 and 12 months demonstrated a significantly lower proportion of AA patients stating that surgery met their expectations (3 months: 47.2% vs 65.5%, p = 0.01; 12 months: 35.7% vs 62.7%, p = 0.007).CONCLUSIONSThe study data suggest that there is a significant difference in the perception of health, pain, and disability between AA and white patients at baseline and short- and long-term follow-ups, which may influence overall patient satisfaction. Further research is necessary to identify patient-specific factors associated with racial disparities that may be influencing outcomes to adequately measure and assess overall PROs and satisfaction after elective lumbar spine surgery.

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The Potential Effect of Racial Disparities on Outcomes After Spine Surgery: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study

Neurosurgery ◽

10.1093/neuros/nyz310_402 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Mohamed Macki ◽

Michael Bazydlo ◽

Hesham M Zakaria ◽

Lonni Shultz ◽

Jad Khalil ◽

...

Keyword(s):

African American ◽

Return To Work ◽

Racial Disparities ◽

Racial Differences ◽

Spine Surgery ◽

Potential Effect ◽

Lumbar Spine Surgery ◽

Healthcare Outcomes ◽

Wide Range ◽

Patient Reported

Abstract INTRODUCTION Racial disparities have been demonstrated to affect healthcare outcomes over a wide range of disease processes. This goal of this study is to evaluate how race may influence outcomes after elective lumbar spine surgery. METHODS MSSIC was queried for all lumbar operations. Race is a patient reported measure and was stratified into three groups (Caucasian, African-American, others). Demographic information, pre-existing comorbidities, baseline PROs including ODI, NRS, EQ5D, and procedure type (number of levels, fusion) were compared across the three groups. Primary outcome measures were the NASS Patient Satisfaction Index, meeting the MCID for PROs, and return to work at 1 and 2 yr after surgery. Poisson GEE models were done to assess racial differences while adjusting for other patient characteristics. RESULTS A total of 19 191 patients were included in this analysis, 16 788 Caucasian, 1436 African-American, 967 other. Compared to Caucasians, African-Americans had higher proportions of smokers (23% vs 17%), diabetes (32% vs 20%), depression (40% vs 34%), and fusions (56% vs 49%), and greater baseline ODI (55.6 ± 16.0 vs 47.7 ± 16.2). African-American patients had significant associations with dissatisfaction after surgery (RR 1.74 at 1 yr, RR 1.86 at 2 yr), less likely to achieve MCID for ODI (RR 0.87 at 1 yr, RR 0.85 at 2 yr), and less likely to return to work (RR 0.78 at 1 yr, RR 0.82 at 2 yr). After adjusting for baseline factors and postoperative factors (ongoing depression, improvement in PRO, complications) the only significant associations were for patient dissatisfaction (RR 1.36 at 1 yr, RR 1.41 at 2 yr). CONCLUSION Despite significant baseline differences, when adjusting for potential confounding factors, there appears to be an association with race and satisfaction after surgery. Further study into factors to mitigate this disparity are necessary to enhance delivery of care and patient perceptions, regardless of race.

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