Portending Influence of Racial Disparities on Extended Length of Stay after Elective Anterior Cervical Discectomy and Interbody Fusion for Cervical Spondylotic Myelopathy

Elsamadicy, Aladine A.; Koo, Andrew B.; David, Wyatt B.; Sarkozy, Margot; Freedman, Isaac G.; Reeves, Benjamin C.; Laurans, Maxwell; Kolb, Luis; Sciubba, Daniel M.

doi:10.1016/j.wneu.2020.06.155

Cited by 19 publications

(35 citation statements)

References 41 publications

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“…First, our analysis used a large comprehensive dataset of medical and surgical admissions from diverse states in the US which allowed us to detect aALOS differences, compared to studies which have examined racial/ethnic and SES differences within only specific diseases or procedures. 8,9,32,34,35 Second, because our analysis controlled for differences in admission diagnoses using DRGs our findings have broader applicability to policies focused on LOS metrics at the ward and hospital level, rather than for individuals diagnoses.…”

Section: Discussionmentioning

confidence: 96%

“…To our knowledge, this is the first study to examine trends in adjusted LOS differences by race/ethnicity and SES in a US setting across both medical and surgical admissions. Although evidence is limited to particular patient groups, several studies have highlighted in cross-sectional analyses both racial/ethnic and SES-related differences in adjusted LOS across single institutions, which have demonstrated Black-White differences of 0.4 to 2 days in adjusted LOS in colorectal 8 and spinal surgery populations, 32 and SES differences of 0.3 to 0.7 days among trauma patients 22 and general medical and surgical patients. 33…”

Section: Discussionmentioning

confidence: 99%

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Trends in medical and surgical admission length of stay by race/ethnicity and socioeconomic status: a time series analysis

Ghosh

Unruh

Soroka

et al. 2021

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Length of stay, a metric of hospital efficiency, differs by race/ethnicity and socioeconomic status (SES). Longer LOS is associated with adverse health outcomes. We assessed differences in average adjusted length of stay (aALOS) over time by race/ethnicity, and SES stratified by discharge destination (home or non-home). Using the 2009-2014 State Inpatient Datasets from three states, we examined trends in aALOS differences by race/ethnicity, and SES (defined first vs fourth quartile of median income by zip code) controlling for patient, disease and hospital characteristics. For those discharged home, racial/ethnic and SES aALOS differences remained stable. Notably, for those discharged to non-home destinations, Black vs White, and low vs high SES aALOS differences increased significantly from 2009 to 2013, more sharply after Q3 2011, the introduction of the Affordable Care Act (ACA). Further research to understand the impact of the ACA on hospital efficiencies, and relationship to racial/ethnic and SES differences in LOS is warranted.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Trends in medical and surgical admission length of stay by race/ethnicity and socioeconomic status: a time series analysis

Ghosh

Unruh

Soroka

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…dataset of medical and surgical admissions from diverse states in the US which allowed us to detect aALOS differences, compared to studies which have examined racial/ethnic and SES differences within only specific diseases or procedures. 11,12,[30][31][32] Second, because our analysis controlled for differences in admission diagnoses using DRGs our findings have broader applicability to policies focused on LOS metrics at the ward and hospital level, rather than for individuals diagnoses. Third, our findings demonstrate that like previous studies examining trends in LOS in general, 31,33 there is a general decline in adjusted LOS across the study time period by race/ethnicity and SES (Table 3).…”

Section: Discussionmentioning

confidence: 98%

Trends in Medical and Surgical Admission Length of Stay by Race/Ethnicity and Socioeconomic Status: A Time Series Analysis

Ghosh

Unruh

Soroka

et al. 2021

Health Services Research and Managerial Epidemiology

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Background: Length of stay (LOS), a metric of hospital efficiency, differs by race/ethnicity and socioeconomic status (SES) and longer LOS is associated with adverse health outcomes. Historically, projects to improve LOS efficiency have yielded LOS reductions by 0.3 to 0.7 days per admission. Objective: To assess differences in average adjusted length of stay (aALOS) over time by race/ethnicity, and SES stratified by discharge destination (home or non-home). Method: Data were obtained from 2009-2014 Healthcare Cost and Utilization Project State Inpatient Datasets for New York, New Jersey, and Florida. Multivariate generalized linear models were used to examine trends in aALOS differences by race/ethnicity, and by high vs low SES patients (defined first vs fourth quartile of median income by zip code) controlling for patient, disease and hospital characteristics. Results: For those discharged home, racial/ethnic and SES aALOS differences remained stable from 2009 to 2014. However, among those discharged to non-home destinations, Black vs White aALOS differences increased from 0.21 days in Q1 2009, (95% confidence interval (CI): 0.13 to 0.30) to 0.32 days in Q3 2013, (95% CI: 0.23 to 0.40), and for low vs high SES patients from 0.03 days in Q1 2009 (95% CI: -0.04 to 0.1) to 0.26 days, (95% CI: 0.19 to 0.34). Notably, for patients not discharged home, racial/ethnic and SES aALOS differences increased and persisted after Q3 2011, coinciding with the introduction of the Affordable Care Act (ACA). Conclusion: Further research to understand the ACA’s policy impact on hospital efficiencies, and relationship to racial/ethnic and SES differences in LOS is warranted.

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“…found that hospital region differed significantly between their African American and Caucasian cohorts (p<0.001). [14] Likewise, in an observational study of 134,088 patients who underwent elective ACDF in 2011, Kalakoti et al. reported significant differences in U.S. hospital region between their comorbid and no comorbidity cohorts.…”

Section: Discussionmentioning

confidence: 98%

“…For example, in a retrospective cohort study of 15,400 patients undergoing elective ACDF for CSM using the NIS from 2016 to 2017, Elsamadicy et al found that hospital region differed significantly between their African American and Caucasian cohorts (p < 0.001). [14] Likewise, in an observational study of 134,088 patients who underwent elective ACDF in 2011, Kalakoti et al reported significant differences in U.S. hospital region between their comorbid and no comorbidity cohorts. [8] Similarly, our study found that race, median household income quartile, and healthcare coverage all varied significantly between the North, South, West, and Midwest regions.…”

Section: Discussionmentioning

confidence: 99%

Geographic variations in health care resource utilization following elective ACDF for cervical spondylotic myelopathy: A national trend analysis

Koo

Elsamadicy

Sarkozy

et al. 2022

North American Spine Society Journal (NASSJ)

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Background As health care expenditures continue to increase, standardizing health care delivery across geographic regions has been identified as a method to reduce costs. However, few studies have demonstrated how the practice of elective spine surgery varies by geographic location. The aim of this study was to assess the geographic variations in management, complications, and total cost of elective anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM). Methods The National Inpatient Sample database (2016-2017) was queried using the ICD-10-CM procedural and diagnostic coding systems to identify all adult (≥18 years) patients with a primary diagnosis of CSM undergoing an elective ACDF. Patients were divided into regional cohorts as defined by the U.S. Census Bureau: Northeast, Midwest, South, and West. Weighted patient demographics, Elixhauser comorbidities, perioperative complications, length of stay (LOS), discharge disposition, and total cost of admission were assessed. Results A total of 17,385 adult patients were identified. While the age (p=0.116) and proportion of female patients (p=0.447) were similar among the cohorts, race (p<0.001) and healthcare coverage (p<0.001) varied significantly. The Northeast had the largest proportion of patients in the 76-100th household income quartile (Northeast: 32.1%; Midwest: 16.9%; South: 15.7%; West: 27.5%, p<0.001). Complication rates were similar between regional cohorts (Northeast: 10.1%; Midwest: 12.2%; South: 10.3%; West: 11.9%, p=0.503), as was LOS (Northeast: 2.2±2.4 days; Midwest: 2.1±2.4 days; South: 2.0±2.5 days; West: 2.1±2.4 days, p=0.678). The West incurred the greatest mean total cost of admission (Northeast: $19,167±10,267; Midwest: $18,903±9,114; South: $18,566±10,152; West: $24,322±15,126, p<0.001). The Northeast had the lowest proportion of patients with a routine discharge (Northeast: 72.0%; Midwest: 84.8%; South: 82.3%; West: 83.3%, p<0.001). The odds ratio for Western hospital region was 3.46 [ 95% CI: (2.41, 4.96), p<0.001 ] compared to the Northeast for increased cost. Conclusion Our study suggests that regional variations exist in elective ACDF for CSM, including patient demographics, hospital costs, and nonroutine discharges, while complication rates and LOS were similar between regions.

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Portending Influence of Racial Disparities on Extended Length of Stay after Elective Anterior Cervical Discectomy and Interbody Fusion for Cervical Spondylotic Myelopathy

Cited by 19 publications

References 41 publications

Trends in medical and surgical admission length of stay by race/ethnicity and socioeconomic status: a time series analysis

Trends in medical and surgical admission length of stay by race/ethnicity and socioeconomic status: a time series analysis

Trends in Medical and Surgical Admission Length of Stay by Race/Ethnicity and Socioeconomic Status: A Time Series Analysis

Geographic variations in health care resource utilization following elective ACDF for cervical spondylotic myelopathy: A national trend analysis

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