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Postoperative racial disparities following spine surgery are less pronounced in the outpatient setting.
- Source :
-
The spine journal : official journal of the North American Spine Society [Spine J] 2024 Aug; Vol. 24 (8), pp. 1361-1368. Date of Electronic Publication: 2024 Jan 30. - Publication Year :
- 2024
-
Abstract
- Background Context: Racial disparities in spine surgery have been thoroughly documented in the inpatient (IP) setting. However, despite an increasing proportion of procedures being performed as same-day surgeries, whether similar differences have developed in the outpatient (OP) setting remains to be elucidated.<br />Purpose: This study aimed to investigate racial differences in postoperative outcomes between Black and White patients following OP and IP lumbar and cervical spine surgery.<br />Study Design/setting: Retrospective cohort study.<br />Patient Sample: Patients who underwent IP or OP microdiscectomy, laminectomy, anterior cervical discectomy and fusion (ACDF), or cervical disc replacement (CDR) between 2017 and 2021.<br />Outcome Measures: Thirty-day rates of serious and minor adverse events, readmission, reoperation, nonhome discharge, and mortality.<br />Methods: A retrospective review of patients who underwent IP or OP microdiscectomy, laminectomy, anterior cervical discectomy and fusion (ACDF), or cervical disc replacement (CDR) between 2017 and 2021 was conducted using the National Surgical Quality Improvement Program (NSQIP) database. Disparities between Black and White patients in (1) adverse event rates, (2) readmission rates, (3) reoperation rates, (4) nonhome discharge rates, (5) mortality rates, (6) operative times, and (7) hospital LOS between Black and White patients were measured and compared between IP and OP surgical settings. Multivariable logistic regression analyses were used to adjust for potential effects of baseline demographic and clinical differences.<br />Results: Of 81,696 total surgeries, 49,351 (60.4%) were performed as IP and 32,345 (39.6%) were performed as OP procedures. White patients accounted for a greater proportion of IP (88.2% vs 11.8%) and OP (92.7% vs 7.3%) procedures than Black patients. Following IP surgery, Black patients experienced greater odds of serious (OR 1.214, 95% CI 1.077-1.370, p=.002) and minor adverse events (OR 1.377, 95% CI 1.113-1.705, p=.003), readmission (OR 1.284, 95% CI 1.130-1.459, p<.001), reoperation (OR 1.194, 95% CI 1.013-1.407, p=.035), and nonhome discharge (OR 2.304, 95% CI 2.101-2.528, p<.001) after baseline adjustment. Disparities were less prominent in the OP setting, as Black patients exhibited greater odds of readmission (OR 1.341, 95% CI 1.036-1.735, p=.026) but were no more likely than White patients to experience adverse events, reoperation, individual complications, nonhome discharge, or death (p>.050 for all).<br />Conclusions: Racial inequality in postoperative complications following spine surgery is evident, however disparities in complication rates are relatively less following OP compared to IP procedures. Further work may be beneficial in elucidating the causes of these differences to better understand and mitigate overall racial disparities within the inpatient setting. These decreased differences may also provide promising indication that progress towards reducing inequality is possible as spine care transitions to the OP setting.<br />Competing Interests: Declaration of competing interest One or more of the authors declare financial or professional relationships on ICMJE-TSJ disclosure forms.<br /> (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Female
Humans
Male
Middle Aged
Ambulatory Surgical Procedures statistics & numerical data
Black or African American statistics & numerical data
Cervical Vertebrae surgery
Diskectomy adverse effects
Diskectomy statistics & numerical data
Laminectomy adverse effects
Laminectomy statistics & numerical data
Outpatients statistics & numerical data
Patient Readmission statistics & numerical data
Reoperation statistics & numerical data
Retrospective Studies
White statistics & numerical data
Postoperative Complications epidemiology
Postoperative Complications ethnology
Spinal Fusion statistics & numerical data
Spinal Fusion adverse effects
Health Inequities
Subjects
Details
- Language :
- English
- ISSN :
- 1878-1632
- Volume :
- 24
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- The spine journal : official journal of the North American Spine Society
- Publication Type :
- Academic Journal
- Accession number :
- 38301902
- Full Text :
- https://doi.org/10.1016/j.spinee.2024.01.019