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

Volaski, Harrison; Sharfman, Zachary T.; Shah, Priyam; Eleswarapu, Ananth; Geller, David S.; Krystal, Jonathan

doi:10.1016/j.xnsj.2022.100171

Cited by 3 publications

(5 citation statements)

References 17 publications

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“…42,43 Devotion of resources to overcome language barriers and medical transportation effort may help reduce these disparities. 44,45 Our subanalysis of cost-center-specific charges identified charge differences of $2,110 for Black and $18,657 for Hispanic patients compared with White patients, although this difference was almost 10 times higher for Hispanic patients. Higher accommodation charges accounted for 86% of the difference for Black patients and may present a target for intervention.…”

Section: Discussionmentioning

confidence: 90%

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Impact of Race/Ethnicity on Hospital Resource Utilization After Elective Anterior Cervical Decompression and Fusion for Degenerative Myelopathy

Blackburn

Ahn

et al. 2022

J Am Acad Orthop Surg

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Introduction: With the advent of bundled care payments for spine surgery, there is increasing scrutiny on the costs and resource utilization associated with surgical care. The purpose of this study was to compare (1) the total cost of the hospital episode of care and (2) discharge destination between White, Black, and Hispanic patients receiving elective anterior cervical decompression and fusion for degenerative cervical myelopathy (DCM) in Medicare patients. Methods: The 2019 Medicare Provider Analysis and Review Limited Data Set and the 2019 Impact File were used for this project. Multivariate models were created for total cost and discharge destination, controlling for confounders found on univariate analysis. We then performed a subanalysis for differences in specific cost-center charges. Results: There were 11,506 White (85.4%), 1,707 Black (12.7%), and 261 Hispanic (1.9%) patients identified. There were 6,447 males (47.8%) and 7,027 females (52.2%). Most patients were between 65 to 74 years of age (n = 7,101, 52.7%). The mean cost of the hospital episode was $20,919 6 11,848. Most patients were discharged home (n = 11,584, 86.0%). Race/ethnicity was independently associated with an increased cost of care (Black: $783, Hispanic: $1,566, P = 0.001) and an increased likelihood of nonhome discharge (Black: adjusted odds ratio: 1.990, P , 0.001, Hispanic: adjusted odds ratio: 1.822, P , 0.001) compared with White patients. Compared with White patients, Black patients were charged more for accommodations ($1808

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Section: Discussionmentioning

confidence: 90%

“…42,43 Devotion of resources to overcome language barriers and medical transportation effort may help reduce these disparities. 44,45…”

Section: Discussionmentioning

confidence: 99%

Impact of Race/Ethnicity on Hospital Resource Utilization After Elective Anterior Cervical Decompression and Fusion for Degenerative Myelopathy

Blackburn

Ahn

et al. 2022

J Am Acad Orthop Surg

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“…32,38 Through the TMLE, we also observed a slight increase in the likelihood of a 90-day ED admission among racial and ethnic minority patients, but it is unclear whether this effect may be clinically significant given the small effect size (95% CI, 1.01-1.18); similar findings have been reported in the literature. 1,3,51 In a single-institution series, Volaski et al 51 observed an increased number of 30-day ED visits among patients of Hispanic ethnicity compared with non-Hispanic patients after transforaminal lumbar interbody fusions. 51 The authors suggested this observation may be secondary to limited English proficiency among Spanish-speaking patients and, consequently, incorrect dosing of discharge medications, as previously demonstrated.…”

Section: Discussionmentioning

confidence: 99%

“…1,3,51 In a single-institution series, Volaski et al 51 observed an increased number of 30-day ED visits among patients of Hispanic ethnicity compared with non-Hispanic patients after transforaminal lumbar interbody fusions. 51 The authors suggested this observation may be secondary to limited English proficiency among Spanish-speaking patients and, consequently, incorrect dosing of discharge medications, as previously demonstrated. 24 Finally, Medicare insurance was found to have a significant effect modification on the non-White race as a risk factor for increased 90-day ED visits.…”

Section: Discussionmentioning

confidence: 99%

Identifying Racial Disparities in Utilization and Clinical Outcomes of Ambulatory Hip Arthroscopy: Analysis of Temporal Trends and Causal Inference via Machine Learning

Lu,

Alder,

Marigi

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Arthroscopic diagnosis and treatment of femoroacetabular pathology has experienced significant growth in the last 30 years; nevertheless, reduced utilization of orthopaedic procedures has been observed among the underrepresented population. Purpose/Hypothesis: The purpose of this study was to examine racial differences in case incidence rates, outcomes, and complications in patients undergoing hip arthroscopy. It was hypothesized that racial and ethnic minority patients would undergo hip arthroscopy at a decreased rate compared with their White counterparts but that there would be no differences in clinical outcomes. Study Design: Cross-sectional study. Methods: The State Ambulatory Surgery and Services Database and the State Emergency Department Database of New York were queried for patients undergoing hip arthroscopy between 2011 and 2017. Patients were stratified into White and racial and ethnic minority races, and intergroup comparisons were performed for utilization over time, total charges billed per encounter, 90-day emergency department (ED) visits, and revision hip arthroscopy. Temporal trends in the utilization of hip arthroscopy were identified, and racial differences in secondary outcomes were analyzed with a semiparametric method known as targeted maximum likelihood estimation (TMLE) backed by a library of machine learning algorithms. Results: A total of 9745 patients underwent hip arthroscopy during the study period, with 1081 patients of minority race (11.1%). White patients underwent hip arthroscopy at 5.68 (95% CI, 4.98-6.48) times the incidence rate of racial and ethnic minority patients; these incidence rates grew annually at a ratio of 1.11 in White patients compared with 1.03 in racial and ethnic minority patients ( P < .001). Based on the TMLE, racial and ethnic minority patients were significantly more likely to incur higher costs ( P < .001) and visit the ED within 90 days ( P = .049) but had negligible differences in reoperation rates at a 2-year follow-up ( P = .53). Subgroup analysis identified that higher likelihood for 90-day ED admissions among racial and ethnic minority patients compared with White patients was associated with Medicare insurance ( P = .002), median income in the lowest quartile ( P = .012), and residence in low-income neighborhoods ( P = .006). Conclusion: Irrespective of insurance status, racial and ethnic minority patients undergo hip arthroscopy at a lower incidence and incur higher costs per surgical encounter.

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“…[54][55][56] Decision aids and checklist-style questions improve patient knowledge, accuracy of risk perceptions, and patient comfort with decisions as well as address racial disparities in patients undergoing knee replacement. 55,57 Volaski et al 58 also suggested that overcoming language barriers in order to appropriately outline postoperative expectations may help reduce disparities in outcomes for Hispanic individuals. Surgeon implicit bias also needs to be considered and recognized.…”

Section: Cervical Spinementioning

confidence: 99%

Impact of Racial/Ethnic Disparities on Patient-Reported Outcomes Following Cervical Spine Surgery

Pennings,

Oleisky,

Master

et al. 2024

Spine

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Study Design. Retrospective analysis of data from the cervical module of a national spine registry, the Quality Outcomes Database (QOD). Objective. To examine the association of race and ethnicity with patient-reported outcome measures (PROMs) at 1 year after cervical spine surgery. Summary of Background Data. Evidence suggests that Black individuals are 39% to 44% more likely to have postoperative complications and prolonged length of stay after cervical spine surgery compared to Whites. The long-term recovery assessed with PROMs after cervical spine surgery among Black, Hispanic and other non-Hispanic groups (i.e., Asian) remains unclear. Methods. PROMs were used to assess disability (NDI) and neck/arm pain preoperatively and 1-year postoperative. Primary outcomes were disability and pain, and not being satisfied from pre-operative to 12-months after surgery. Multivariable logistic and proportional odds regression analyses were used to determine the association of racial/ethnic groups (Hispanic, non-Hispanic White (NHW), non-Hispanic Black (NHB), and non-Hispanic Asian (NHA)) with outcomes after covariate adjustment and to compute the odds of each racial/ethnic group achieving MCID 1-year postoperatively. Results. Of the 14,429 participants, all had significant reductions in pain and disability, and 87% were satisfied at 1-year follow-up. Hispanic and NHB patients had higher odds of not being satisfied (40% and 80%) and having worse pain outcomes (30% to 70%) compared to NHW. NHB had 50% higher odds of worse disability scores compared to NHW. NHA reported similar disability and neck pain outcomes compared to NHW. Conclusions. Hispanic and non-Hispanic Black patients had worse patient-reported outcomes 1-year after cervical spine surgery compared to non-Hispanic White individuals, even after adjusting for potential confounders, yet there was no difference in disability and neck pain outcomes reported for non-Hispanic Asian patients. This study highlights the need to address inherent racial/ethnic disparities in recovery trajectories following cervical spine surgery. Level of Evidence. 3

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

Cited by 3 publications

References 17 publications

Impact of Race/Ethnicity on Hospital Resource Utilization After Elective Anterior Cervical Decompression and Fusion for Degenerative Myelopathy

Impact of Race/Ethnicity on Hospital Resource Utilization After Elective Anterior Cervical Decompression and Fusion for Degenerative Myelopathy

Identifying Racial Disparities in Utilization and Clinical Outcomes of Ambulatory Hip Arthroscopy: Analysis of Temporal Trends and Causal Inference via Machine Learning

Impact of Racial/Ethnic Disparities on Patient-Reported Outcomes Following Cervical Spine Surgery

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