Outcomes Following Surgical Management of Cauda Equina Syndrome: Does Race Matter?

Abstract

Cauda equina syndrome (CES) is a surgical emergency requiring urgent spinal decompression. Our objective is to analyze the association between race and in-hospital outcomes (complications, mortality, length of stay, and discharge disposition) in patients with CES. This is a retrospective cohort study of CES patients identified via the Nationwide Inpatient Sample (NIS) from 2000 to 2010 in inpatient hospitalizations in the USA. The patient sample includes 46,017 patients ≥18 undergoing spine surgery for CES. Using ICD9-CM codes, patient records with a diagnosis of CES from 2003 to 2010 were selected from the NIS database and sorted by mortality, complications, length of hospital stay, and discharge status. Demographic information (age, gender, race, and insurance status) and hospital characteristics were evaluated. African-American patients were 1.38-fold (p < 0.02; 95% odds ratio [OR] 1.05-1.83) more likely than Caucasian patients to develop complications based on a multivariate logistic regression model adjusted for patient age, insurance status, surgical approach, and hospital size. There was no difference in mortality among patients of various races in both univariate and multivariate analysis. A multivariate linear regression model adjusted for insurance status, surgical approach, and hospital size revealed that, compared to Caucasian patients, length of hospitalization in African-American patients was 1.92 days longer (p < 0.01), 1.34 days longer (p < 0.01) in Hispanic patients, and 2.24 days longer (p < 0.01) in Asian-American patients. African-American patients were 0.59-fold (p < 0.01; 95% OR 0.494-0.708) less likely than Caucasian patients to have routine discharge to home. African-American patients hospitalized for surgical management of CES experience significantly more complications, longer length of hospitalizations, and higher discharge to non-home locations, compared to Caucasian patients.

Racial Disparities in Surgical Outcomes After Spine Surgery: An ACS-NSQIP Analysis

“…Previous national studies of racial disparity have examined outcomes either by assessing individual surgeries or querying specific diagnosis. 6-8,12,14,20-26 By comparison, we present racial disparities observed between 3 different races (CA, AA, NA) while also considering 3 common spine surgical procedures: cervical fusion (CF), lumbar fusion (LF), and laminectomy (LN). In so doing, we present a comprehensive epidemiological picture of the current state differential delivery of care within the field of spine surgery.…”

Social Determinants of Health Influence Access to Care and Outcomes in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Systematic Review

“…23 Furthermore, public health insurance patients carry higher odds of requiring acute medical care within 30 days after ACLR. 32 Studies investigating the impact race/ethnicity and insurance status have on postoperative complications have reported similar findings among orthopaedic [70][71][72][73][74] and spine 75,76 patients. These findings emphasize the disparity in access to care between patient populations experiencing social deprivation or social support as the result of their SDOH, which directly affect outcomes after ACLR.…”

Minimally invasive discectomy versus open laminectomy and discectomy for the treatment of cauda equina syndrome: A preliminary study and case series

“…Special interest was given to the correlation between the timing of surgery and patients' post-operative neurological outcomes. Although most authors recommended urgent surgical decompression in this setting, critical analysis of the literature leading to this conclusion is not conclusive ( 5 , 8 ).…”

“…Severe possible consequences of this condition may include bowel and/or bladder dysfunction and motor weakness of the lower limbs. Therefore the recommended treatment option is urgent surgical decompression of the spinal canal, which includes the removal of the herniated disc fragment (5)(6)(7). Urgent surgical intervention has been found to be most effective in cases of incomplete neurological damage and when it is done within the first 48 h of presentation (3).…”