The Effect of Patient Race on Extent of Functional Improvement After Cervical Spine Surgery

Elsamadicy, Aladine A.; Adogwa, Owoicho; Reiser, Elizabeth; Fatemi, Parastou; Cheng, Joseph; Bagley, Carlos A.

doi:10.1097/brs.0000000000001346

Cited by 21 publications

(13 citation statements)

References 12 publications

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“…38,39 However, the impact of race on surgical outcomes following spinal surgery is controversial, and other studies have found no disparity in outcome. 40 The ASA classification is used to evaluate the overall health and medical comorbidities of patients prior to surgery, and can be used to predict patient outcomes. 41 ASA scores have been shown to affect mortality rates, LOS, and readmission rates in spine surgery.…”

Section: Discussionmentioning

confidence: 99%

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Factors Associated With Extended Length of Stay and 90-Day Readmission Rates Following ACDF

Dial

Esposito

Danilkowicz

et al. 2019

Global Spine Journal

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Study Design: Retrospective. Objective: Identify patient risk factors for extended length of stay (LOS) and 90-day hospital readmissions following elective anterior cervical discectomy and fusion (ACDF). Methods: Included ACDF patients from 2013 to 2017 at a single institution. Eligible patients were subset into LOS <2 and LOS ≥2 days, and no 90-day hospital readmission and yes 90-day hospital readmission. Patient and surgical factors were compared between the LOS and readmission groups. Multivariable logistic regression analysis was utilized to determine the association of independent factors with LOS and 90-day readmission rates. Results: Our sample included 1896 patients; 265 (14%) had LOS ≥2 days, and 121 (6.4%) had a readmission within 90 days of surgery. Patient and surgical factors associated with LOS included patient age ≥65 years (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.15-2.56), marriage (OR 0.57, 95% CI 0.43-0.79), private health insurance (OR 0.28, 95% CI 0.15-0.50), American Society of Anesthesiologists (ASA) score (OR 1.52, 95% CI 1.12-1.86), African American race (OR 1.95, 95% CI 1.38-2.72), and harvesting iliac crest autograft (OR 4.94, 95% CI 2.31-10.8). Patient and surgical factors associated with 90-day hospital readmission included ASA score (OR 1.81, 95% CI 1.32-2.49), length of surgery (OR 1.002, 95% CI 1.001-1.004), and radiculopathy as indication for surgery (OR 0.60, 95% CI 0.39-0.96). Conclusions: Extended LOS and 90-day hospital readmissions may lead to poorer patient outcomes and increased episode of care costs. Our study identified patient and surgical factors associated with extended LOS and 90-day readmission rates. In general, preoperative patient factors affected these outcomes more than surgical factors.

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Section: Discussionmentioning

confidence: 99%

“…38,39 However, the impact of race on surgical outcomes following spinal surgery is controversial, and other studies have found no disparity in outcome. 40…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Extended Length of Stay and 90-Day Readmission Rates Following ACDF

Dial

Esposito

Danilkowicz

et al. 2019

Global Spine Journal

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“…However, other racial and ethnic groups are often studied together as a combined cohort, rarely reporting on the burden encountered specifically as it relates to these racial populations. 5,8 -14 Little to no data is currently available regarding Native American (NA) recipients of spinal surgery or among the field of orthopedic surgical research at large. 15 This is of special concern considering the increased incidences of multiple health conditions including obesity, diabetes, physical disability, and substance abuse observed in NA communities often within the context of staggeringly low access to health care.…”

Section: Introductionmentioning

confidence: 99%

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

Sanford

Taylor

Fiorentino

et al. 2018

Global Spine Journal

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Study Design: Retrospective cohort study. Objectives: Racial disparities in postoperative outcomes are unfortunately common. We present data assessing race as an independent risk factor for postoperative complications after spine surgery for Native American (NA) and African American (AA) patients compared with Caucasians (CA). Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for spine procedures performed in 2015. Data was subdivided by surgery, demography, comorbidity, and 30-day postoperative outcomes, which were then compared by race. Regression was performed holding race as an independent risk factor. Results: A total of 4803 patients (4106 CA, 522 AA, 175 NA) were included in this analysis. AA patients experienced longer length of stay (LOS) and operative times ( P < .001) excluding lumbar fusion, which was significantly shorter ( P = .035). AA patients demonstrated higher comorbidity burden, specifically for diabetes and hypertension ( P < .005), while NA individuals were higher tobacco consumers ( P < .001). AA race was an independent risk factor associated with longer LOS across all cervical surgeries (β = 1.54, P <.001), lumbar fusion (β = 0.77, P = .009), and decompression laminectomy (β = 1.23, P < .001), longer operative time in cervical fusion (β = 12.21, P = .032), lumbar fusion (β = -24.00, P = .016), and decompression laminectomy (OR = 20.95, P < .001), greater risk for deep vein thrombosis in lumbar fusion (OR = 3.72, P = .017), and increased superficial surgical site infections (OR = 5.22, P = .001) and pulmonary embolism (OR = 5.76, P = .048) in decompression laminectomy. NA race was an independent risk factor for superficial surgical site infections following cervical fusion (OR = 14.58, P = .044) and decompression laminectomy (OR = 4.80, P = .021). Conclusion: AA and NA spine surgery patients exhibit disproportionate comorbidity burden and greater 30-day complications compared with CA patients. AA and NA race were found to independently affect rates of complications, LOS, and operation time.

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“…Kim et al found that Hispanic and Asian/Pacific Islander patients were less likely to receive a fusion for a similar diagnosis compared to White patients ( p -value < 0.001) [ 82 ]. However, in a different study using institutional data, Elsamadicy et al found no significant difference among Black and White patients with regards to neck disability index, VAS, or SF-12 at 3-months and 12-months after ACDF [ 83 ]. Finally, Wang et al studied racial disparities in the setting of adult spinal deformity [ 84 ].…”

Section: Racementioning

confidence: 99%

“…Uninsured individuals, who represented about 8.6% of the population in 2020, often lack primary care providers and face financial barriers to critical health care operations and medications [ 85 , 87 ]. Moreover, disparities in health outcomes between individuals of different health insurance groups—including private insurance, public insurance, and uninsured—have been shown to exist[ 83 ]…”

Section: Healthcare Accessmentioning

confidence: 99%

Impact of Social Determinants of Health in Spine Surgery

Reyes

Bajaj

Alvandi

et al. 2022

Curr Rev Musculoskelet Med

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Purpose of Review Social determinants of health (SDH) are factors that affect patient health outcomes outside the hospital. SDH are “conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Current literature has shown SDH affecting patient reported outcomes in various specialties; however, there is a dearth in research relating spine surgery with SDH. The aim of this review article is to identify connections between SDH and post-operative outcomes in spine surgery. These are important, yet understudied predictors that can impact health outcomes and affect health equity. Recent Findings Few studies have shown associations between SDH pillars (environment, race, healthcare, economic, and education) and spine surgery outcomes. The most notable relationships demonstrate increased disability, return to work time, and pain with lower income, education, environmental locations, healthcare status and/or provider. Despite these findings, there remains a significant lack of understanding between SDH and spine surgery. Summary Our manuscript reviews the available literature comparing SDH with various spine conditions and surgeries. We organized our findings into the following narrative themes: 1) education, 2) geography, 3) race, 4) healthcare access, and 5) economics.

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The Effect of Patient Race on Extent of Functional Improvement After Cervical Spine Surgery

Abstract: 3.

Cited by 21 publications

References 12 publications

Factors Associated With Extended Length of Stay and 90-Day Readmission Rates Following ACDF

Factors Associated With Extended Length of Stay and 90-Day Readmission Rates Following ACDF

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

Impact of Social Determinants of Health in Spine Surgery

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