Racial Disparities in Spine Surgery

Abstract

Study Design: Systematic Review. Objectives: To synthesize previous studies evaluating racial disparities in spine surgery. Methods: We queried PubMed, Embase, Cochrane Library, and Web of Science for literature on racial disparities in spine surgery. Our review was constructed in accordance with Preferred Reporting Items and Meta-analyses guidelines and protocol. The main outcome measures were the occurrence of racial disparities in postoperative outcomes, mortality, surgical management, readmissions, and length of stay. Results: A total of 1753 publications were assessed. Twenty-two articles met inclusion criteria. Seventeen studies compared Whites (Ws) and African Americans (AAs) groups; 14 studies reported adverse outcomes for AAs. When compared with Ws, AA patients had higher odds of postoperative complications including mortality, cerebrospinal fluid leak, nervous system complications, bleeding, infection, in-hospital complications, adverse discharge disposition, and delay in diagnosis. Further, AAs were found to have increased odds of readmission and longer length of stay. Finally, AAs were found to have higher odds of nonoperative treatment for spinal cord injury, were more likely to undergo posterior approach in the treatment of cervical spondylotic myelopathy, and were less likely to receive cervical disk arthroplasty compared with Ws for similar indications. Conclusions: This systematic review of spine literature found that when compared with W patients, AA patients had worse health outcomes. Further investigation of root causes of these racial disparities in spine surgery is warranted.

Disparities in postoperative complications and perioperative events based on insurance status following elective spine surgery: A systematic review and meta-analysis

“…Therefore, if a study provided re-admission data for 0 to 30 days and 31 to 90 days after surgery, these values were combined to report a single value for 90-day readmission. These parameters were chosen because they are well-studied metrics for assessing the outcomes of major surgeries [22] and have been widely reported in previous systematic reviews on disparities in spine surgery [ 23 , 24 ].…”

“…For example, racial differences could be contributing to our results. It is well documented that African American patients are more likely to experience an adverse event following spine surgery, including outcomes that were examined in this study [24] . Since African Americans are more likely to be on government insurance than White patients [ 12 , 53 ], race could be a confounding variable that contributes to the increased likelihood of adverse outcomes that we found in government insured patients.…”