Impact of race on outcomes and healthcare utilization following spinal fusion for adolescent idiopathic scoliosis

Elsamadicy, Aladine A.; Koo, Andrew B.; David, Wyatt B.; Freedman, Isaac G.; Kundishora, Adam J.; Hong, Christopher S.; Sarkozy, Margot; Sciubba, Daniel M.; Kahle, Kristopher T.; DiLuna, Michael L.

doi:10.1016/j.clineuro.2021.106634

Cited by 10 publications

(11 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…They will be used in a separate study to develop evidence-based recommendations for economic evaluations in spine surgery. Finally, a total of 130 clinical cost-effectiveness studies were included 24–153…”

Section: Resultsmentioning

confidence: 99%

Methodology of economic evaluations in spine surgery: a systematic review and qualitative assessment

et al. 2023

View full text Add to dashboard Cite

ObjectivesThe present study is a systematic review conducted as part of a methodological approach to develop evidence-based recommendations for economic evaluations in spine surgery. The aim of this systematic review is to evaluate the methodology and quality of currently available clinical cost-effectiveness studies in spine surgery.Study designSystematic literature review.Data sourcesPubMed, Web of Science, Embase, Cochrane, Cumulative Index to Nursing and Allied Health Literature, EconLit and The National Institute for Health Research Economic Evaluation Database were searched through 8 December 2022.Eligibility criteria for selecting studiesStudies were included if they met all of the following eligibility criteria: (1) spine surgery, (2) the study cost-effectiveness and (3) clinical study. Model-based studies were excluded.Data extraction and synthesisThe following data items were extracted and evaluated: pathology, number of participants, intervention(s), year, country, study design, time horizon, comparator(s), utility measurement, effectivity measurement, costs measured, perspective, main result and study quality.Results130 economic evaluations were included. Seventy-four of these studies were retrospective studies. The majority of the studies had a time horizon shorter than 2 years. Utility measures varied between the EuroQol 5 dimensions and variations of the Short-Form Health Survey. Effect measures varied widely between Visual Analogue Scale for pain, Neck Disability Index, Oswestry Disability Index, reoperation rates and adverse events. All studies included direct costs from a healthcare perspective. Indirect costs were included in 47 studies. Total Consensus Health Economic Criteria scores ranged from 2 to 18, with a mean score of 12.0 over all 130 studies.ConclusionsThe comparability of economic evaluations in spine surgery is extremely low due to different study designs, follow-up duration and outcome measurements such as utility, effectiveness and costs. This illustrates the need for uniformity in conducting and reporting economic evaluations in spine surgery.

show abstract

Section: Resultsmentioning

confidence: 99%

Methodology of economic evaluations in spine surgery: a systematic review and qualitative assessment

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Black adolescents also appear to be at increased risk for blood loss and transfusion-related adverse events. Elsamadicy et al used the Kids’ Inpatient Database to investigate differences in intraoperative care and postoperative outcomes for adolescents with idiopathic scoliosis undergoing posterior spinal fusion [ 59 ]. The authors found that a greater proportion of Black adolescents required blood transfusion compared to White children.…”

Section: Intraoperative Racial Disparitiesmentioning

confidence: 99%

“…Even without prolonged LOS, minority children likely incur increased hospital charges. An analysis of the KID for 2012 that included 3400 adolescents with idiopathic scoliosis undergoing posterior spinal fusion revealed that despite similar length of stay between children of different races, Hispanic children had significantly increased hospital costs compared to White children [ 59 ]. Most recently, a study by Mpody et al estimated the economic burden of racial disparities in appendectomy-related complications to be nearly $60,000,000 between 2001 and 2018 [ 77 ••].…”

Section: Postoperative Racial Disparitiesmentioning

confidence: 99%

Racial Inequity in Pediatric Anesthesia

Willer

Mpody

Nafiu

2023

Curr Anesthesiol Rep

View full text Add to dashboard Cite

Purpose of Review Minority health disparities have received renewed attention in the USA following several highly publicized racial injustices in 2020. Though the focus has been largely on adults, children are not immune to these inequities. By reviewing racial disparities in pediatric perioperative care, we aim to engage the anesthesia community in the fight against systemic racism. Recent Findings Minority children have higher rates of anesthetic and surgical morbidity compared to White children, including respiratory events, length of stay, hospital costs, and even death. These inequities occur across surgical specialties and environments. Summary Racial disparities in the perioperative health and management of children are ubiquitous. Herein, we will summarize recent pediatric health disparity literature, discuss some important contributors to persistent inequities, and propose avenues for anesthesiologists to impact the pursuit of equitable healthcare outcomes.

show abstract

“…The rates of blood transfusions after posterior spinal fusion for AIS have been found to be markedly higher in the Black population, although no clear etiology has been identified. 31 A study looking at early postoperative complications after posterior spine fusion for AIS noted slightly increased rates of venous thromboembolism in Black patients, after controlling for baseline factors, including higher BMI, more female patients, higher ASA scores, preoperative diagnosis of asthma or cardiac risk factors, and prior use of steroids. 32…”

Section: Scoliosismentioning

confidence: 99%

Orthopaedic Diagnoses in the Black Pediatric Population

Bridges

Agarwal

Raney

2023

J Am Acad Orthop Surg

View full text Add to dashboard Cite

The Black pediatric population is one that has been historically underserved and continues to have unmet needs. Factors including lack of diversity in orthopaedic studies and in historical standards, such as bone age, may inadvertently lead to inferior care. There are certain conditions in this population for which the practicing orthopaedic surgeon should have a higher degree of suspicion, including slipped capital femoral epiphysis, Blount disease, and postaxial polydactyly. Systemic diseases with higher rates in this population have orthopaedic manifestations, including sickle cell disease, vitamin D deficiency, and obesity. Racial discrepancies in access to prenatal care can have orthopaedic consequences for babies, especially cerebral palsy and myelodysplasia. Racial discrepancy exists in evaluation for nonaccidental trauma. Increased awareness of these issues better prepares practitioners to provide equitable care. D r. Martin Luther King Jr. stated that "of all forms of inequity, injustice in health care is the most shocking and inhumane." 1 Differences in care exist at all levels of the healthcare delivery system based on socioeconomic status and race. Access to primary care, treatment in the emergency department, and hospital treatment have all been found to have racial discrepancies, with Black children most commonly ending up with less care and poorer quality of care. 2 In the emergency department, patient race can affect analgesia, triage scores, wait times, treatments, diagnostic procedure utilization, rates of patients leaving without being seen, and patient experiences. 3 One particularly problematic area is in the treatment of pain. Opioid treatment of pain in adolescents has been found to favor treating non-Hispanic White patients over minorities. A study by Phan et al 2 demonstrated variability in treating pain based on race for the same diagnoses. These trends persist into adulthood, with pain in the Black population being ignored or undertreated across fields and through the end of life. Extensive work has been done in the past 5 years looking at persistent racial disparities in pediatric surgical outcomes and anesthesia. 4 Variability in surgical outcome has previously been attributed to baseline preoperative characteristics. Recent studies demonstrate that even when controlling for American Society of Anesthesiologists (ASA) scores, Black children have

show abstract

Impact of race on outcomes and healthcare utilization following spinal fusion for adolescent idiopathic scoliosis

Cited by 10 publications

References 30 publications

Methodology of economic evaluations in spine surgery: a systematic review and qualitative assessment

Methodology of economic evaluations in spine surgery: a systematic review and qualitative assessment

Racial Inequity in Pediatric Anesthesia

Orthopaedic Diagnoses in the Black Pediatric Population

Contact Info

Product

Resources

About