Influence of racial disparities on patient-reported satisfaction and short- and long-term perception of health status after elective lumbar spine surgery

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>In spine surgery, racial disparities have been shown to impact various aspects of surgical care. Previous studies have associated racial disparities with inferior surgical outcomes, including increased complication and 30-day readmission rates after spine surgery. Recently, patient-reported outcomes (PROs) and satisfaction measures have been proxies for overall quality of care and hospital reimbursements. However, the influence that racial disparities have on short- and long-term PROs and patient satisfaction after spine surgery is relatively unknown. The aim of this study was to investigate the impact of racial disparities on 3- and 12-month PROs and patient satisfaction after elective lumbar spine surgery.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>This study was designed as a retrospective analysis of a prospectively maintained database. The medical records of adult (age ≥ 18 years) patients who had undergone elective lumbar spine surgery for spondylolisthesis (grade 1), disc herniation, or stenosis at a major academic institution were included in this study. Patient demographics, comorbidities, postoperative complications, and 30-day readmission rates were collected. Patients had prospectively collected outcome and satisfaction measures. Patient-reported outcome instruments—Oswestry Disability Index (ODI), visual analog scale for back pain (VAS-BP), and VAS for leg pain (VAS-LP)—were completed before surgery and at 3 and 12 months after surgery, as were patient satisfaction measures.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The authors identified 345 medical records for 53 (15.4%) African American (AA) patients and 292 (84.6%) white patients. Baseline patient demographics and comorbidities were similar between the two cohorts, with AA patients having a greater body mass index (33.1 ± 6.6 vs 30.2 ± 6.4 kg/m<jats:sup>2</jats:sup>, p = 0.005) and a higher prevalence of diabetes (35.9% vs 16.1%, p = 0.0008). Surgical indications, operative variables, and postoperative variables were similar between the cohorts. Baseline and follow-up PRO measures were worse in the AA cohort, with patients having a greater baseline ODI (p &lt; 0.0001), VAS-BP score (p = 0.0002), and VAS-LP score (p = 0.0007). However, mean changes from baseline to 3- and 12-month PROs were similar between the cohorts for all measures except the 3-month VAS-BP score (p = 0.046). Patient-reported satisfaction measures at 3 and 12 months demonstrated a significantly lower proportion of AA patients stating that surgery met their expectations (3 months: 47.2% vs 65.5%, p = 0.01; 12 months: 35.7% vs 62.7%, p = 0.007).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The study data suggest that there is a significant difference in the perception of health, pain, and disability between AA and white patients at baseline and short- and long-term follow-ups, which may influence overall patient satisfaction. Further research is necessary to identify patient-specific factors associated with racial disparities that may be influencing outcomes to adequately measure and assess overall PROs and satisfaction after elective lumbar spine surgery.</jats:p></jats:sec>

Predictors of patient dissatisfaction at 1 and 2 years after lumbar surgery

“…Elsamadicy et al, in their study of 345 patients who had undergone elective lumbar surgery, demonstrated that African American patients were more likely to report lower satisfaction with their surgery at 3 months and at 1 year. 15 In their meta-analysis of 128,635 patients who had undergone spine surgery, Schoenfeld et al showed that non-white patients had a higher risk of an unfavorable outcome than their white counterparts. 39 In a corollary study of the Spine Patient Outcomes Research Trial (SPORT), Schoenfeld et al documented better PROs in white patients than in African American patients regardless of the treatment arm (surgical intervention and nonoperative management).…”

Quantifying the collective influence of social determinants of health using conditional and cluster modeling

“…The differences observed between the YML and YWH subgroups were the most profound among the subgroups, especially with patient satisfaction, which exhibited the widest variation in success probability. The influence of various SDoH such as insurance and race on patient satisfaction has been previously documented in the surgical literature [17,50]. The disparities seen in pain and disability have not previously been observed and begin to justify the need for more robust methods of quantifying the relationships between various SDoH [4,51].…”

“…Five pre-operative SDoH variables were selected based on the Commission on Social Determinants of Health Final Report published by World Health Organization [22]. The variables included race/ethnicity, educational attainment, employment status, insurance payer, and gender, which were dichotomized based on previous research findings [4,17,[23][24][25][26] to improve interpretability of findings.…”

“…To date, only small scale studies have evaluated individuals' SDoH for spine surgery [4,[14][15][16][17][18], suggesting that these factors do individually influence outcomes. However, SDoH variables do not routinely exist in singularity.…”

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

“…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.…”