Black Race as a Social Determinant of Health and Outcomes After Lumbar Spinal Fusion Surgery

Abstract

Study Design. A retrospective analysis of patient hospitalization and discharge records. Objective. To examine the association between race and inpatient postoperative complications following lumbar spinal fusion surgery. Summary of Background Data. Racial disparities in healthcare have been demonstrated across a range of surgical procedures. Previous research has identified race as a social determinant of health that impacts outcomes after lumbar spinal fusion surgery. However, these studies are limited in that they are outdated, contain data from a single institution, analyze small limited samples, and report limited outcomes. Our study aims to expand and update the literature examining the association between race and inpatient postoperative complications following lumbar spine surgery. Methods. We analyzed 267,976 patient discharge records for inpatient lumbar spine surgery using data from the Healthcare Cost and Utilization Project's State Inpatient Databases for California, Florida, New York, Maryland, and Kentucky from 2007 through 2014. We used unadjusted bivariate analysis, adjusted multivariable, and stratified analysis to compare patient demographics, present-on-admission comorbidities, hospital characteristics, and complications by categories of race/ethnicity. Results. Black patients were 8% and 14% more likely than white patients to experience spine surgery specific complications (adjusted odds ratios [aOR]: 1.08, 95% confidence interval [CI]: 1.03–1.13) and general postoperative complications (aOR: 1.14, 95% CI: 1.07–1.20), respectively. Black patients, compared with white patients, also had increased adjusted odds of 30-day readmissions (aOR: 1.13, 95% CI: 1.07–1.20), 90-day readmissions (aOR: 1.07, 95% CI: 1.02–1.13), longer length of stay (LOS) (adjusted Incidence Rate Ratio: 1.15, 95% CI: 1.14–1.16), and higher total charges (adjusted Incidence Rate Ratio: 1.08, 95% CI: 1.07–1.09). Conclusion. Our findings demonstrate that black patients, as compared with white patients, are more likely to have postoperative complications, longer postoperative lengths of stay, higher total hospital charges, and increased odds of 30- and 90-day readmissions following lumbar spinal fusion surgery. Level of Evidence: 4

Association Between Social Determinants of Health and Postoperative Outcomes in Patients Undergoing Single-Level Lumbar Fusions

“…To date, studies evaluating a potential role of these disparities among patients undergoing single-level lumbar fusions have solely focused upon race/ethnicity, household income, and insurance and have not elucidated the impact of other SDH. [9][10][11] To this end, the present study explores the potential impact of SDH on specific postoperative outcomes among patients undergoing single-level lumbar fusions.…”

Do racial disparities exist in a spine surgery practice that serves a predominately minority population? Outcomes of transforaminal lumbar interbody fusion: A retrospective review

“…Minority patients have been reported to have longer post-operative hospital stays when compared to their White counterparts [ 3 , [7] , [8] , [9] ]. A recent retrospective cohort study, by Reyes et al ., evaluated national discharge data of over 149,000 patients who underwent a lumbar spinal fusion in 2016.…”

“…Minority patients have been reported to have longer post-operative hospital stays when compared to their White counterparts. [3], [7]- [9] A recent retrospective cohort study, by Reyes et al, evaluated national discharge data of over 149,000 patients who underwent a lumbar spinal fusion in 2016. The authors reported that Black and Hispanic patients had longer LOS and higher rates of prolonged LOS than White patients who underwent the same procedure.…”

“…Minority patients have historically experienced higher rates of post-operative complications than White patients. [3], [7]- [9] In a retrospective review of national data, Reyes et al found that Black and Hispanic patients had higher rates of inpatient medical complications than White patients and that Hispanics had higher rates of surgical complications than White patients. [3] In a separate retrospective review of over 2,800 patients who underwent spinal surgery for lumbar stenosis, Black patients were found to have twice the risk of post-operative complications when compared to White patients.…”

“…Black patients, for example, are less likely to undergo spine fusion surgeries than White patients with similar pathologies [4] , [5] , [6] . More worrisome is that when minority patients do undergo spinal fusion procedures, they often experience inferior post-operative outcomes [ 5 , 7 ], incur more costs [ 3 , 8 , 9 ], and experience increased morbidity and mortality [ 4 , 8 , [10] , [11] , [12] , [13] ]. However, these findings have been largely reported from datasets where minority patients were underrepresented.…”