Racial Differences in Patients Undergoing Anterior Cervical Discectomy and Fusion

Abstract

Objective: The objective of this study was to examine disparities within patients undergoing anterior cervical discectomy and fusion (ACDF) at a multi-site tertiary referral center with specific focus on factors related to length of stay (LOS). Summary of Background Data:There are previously described racial disparities in spinal surgery outcomes and quality metrics.Methods: A total of 278 consecutive patients undergoing ACDF by 8 different surgeons over a 5-year period were identified retrospectively. Demographic data, including age at time of surgery, sex, smoking status, and self-identified race [White or African American (AA)], as well as surgical data and postoperative course were recorded. Preoperative health status was recorded, and comorbidities were scored by the Charlson Comorbidity Index. Univariable and multivariable linear regression models were employed to quantify the degree to which a patient's LOS was related to their selfidentified race, demographics, and perioperative clinical data.Results: Of the 278 patients who received an ACDF, 71.6% (199) self-identified as White and 28.4% (79) identified as AA. AA patients were more likely to have an ACDF due to myelopathy, while White patients were more likely to have an ACDF due to radiculopathy (P = 0.001). AA patients had longer LOS by an average of half a day (P = 0.001) and experienced a larger percentage of extended stays (P = 0.002). AA patients experienced longer overall operation times on average (P = 0.001) across all different levels of fusion. AA race was not an independent driver of LOS (β = 0.186; P = 0.246).Conclusions: As hypothesized, and consistent with previous literature on racial surgical disparities, AA race was associated with increased LOS, increased operative times, and increased indication of myelopathy in this study. Additional research is necessary to evaluate the underlying social determinants of health and other factors that may contribute to this study's results.

Racial Differences in Perioperative Complications, Readmissions, and Mortalities After Elective Spine Surgery in the United States: A Systematic Review Using AI-Assisted Bibliometric Analysis

“…13 AA patients had increased length of stays and operative times for anterior cervical decompression and fusion across different fusion levels. 14 AA patients also had an increased risk of medical complications after lumbar decompression and fusion surgery, in particular cardiac, renal, and respiratory adverse events. 14 Pooled analyses in spine surgery further support the outcomes gap between White and AA patients.…”

“…14 AA patients also had an increased risk of medical complications after lumbar decompression and fusion surgery, in particular cardiac, renal, and respiratory adverse events. 14 Pooled analyses in spine surgery further support the outcomes gap between White and AA patients. A meta-analysis in 2011 by Schoenfeld et al 15 analyzed 11 articles and eight "unfavorable" outcome measures, reporting that non-White patients were more likely to have unfavorable outcomes.…”

“… 14 AA patients also had an increased risk of medical complications after lumbar decompression and fusion surgery, in particular cardiac, renal, and respiratory adverse events. 14 …”