Trends in Outpatient Cervical Spine Surgery: Are There Emerging Disparities?

Abstract

Study Design. Retrospective analysis on prospectively collected data. Objective. The purposes of this study were to (1) assess disparities in relative utilization of outpatient cervical spine surgery between White and Black patients from 2010 to 2019 and (2) to measure how these racial differences have evolved over time. Summary of Background Data. Although outpatient spine surgery has become increasingly popularized over the last decade, it remains unknown how racial disparities in surgical utilization have translated to the outpatient setting and whether restrictive patterns of access to outpatient cervical spine procedures may exist. Methods. A retrospective cohort study from 2010 to 2019 was conducted using the National Surgical Quality Improvement Program database. Relative utilization of outpatient (same-day discharge) for anterior cervical discectomy and fusion (OP-ACDF) and cervical disk replacement (OP-CDR) were assessed and trended over time between races. Multivariable regressions were subsequently utilized to adjust for baseline patient factors and comorbidities. Results. Overall, Black patients were significantly less likely to undergo OP-ACDF or OP-CDR surgery when compared with White patients (P<0.03 for both OP-ACDF and OP-CDR). From 2010 to 2019, a persisting disparity over time was found in outpatient utilization for both ACDF and CDR (e.g. White vs. Black OP-ACDF: 6.0% vs. 3.1% in 2010 compared with 16.7% vs. 8.5% in 2019). These results held in all adjusted analyses. Conclusions. To our knowledge, this is the first study reporting racial disparities in outpatient spine surgery and demonstrates an emerging disparity in outpatient cervical spine utilization among Black patients. These restrictive patterns of access to same-day outpatient hospital and surgery centers may contribute to broader disparities in the overall utilization of major spine procedures that have been previously reported. Renewed interventions are needed to both understand and address these emerging inequalities in outpatient care before they become more firmly established within our orthopedic and neurosurgery spine delivery systems.

Improving Racial and Ethnic Disparities in Outpatient Anterior Cervical Discectomy and Fusion Driven by Increasing Utilization of Ambulatory Surgical Centers in New York State

“…Consistent with prior methods, temporal trends in disparities were assessed by plotting crude and age/sexstandardized utilization rates over the study period and assessing for trends using Poisson regression and an interaction term between race and calendar year. 9,30,32 An additional adjusted trends analysis was then performed while controlling several baseline patient-related variables.…”

“…29 Patients who underwent OP-ACDF were identified using Current Procedural Terminology (CPT) codes consistent with prior studies. 30 Outpatient procedures were then further categorized as having been performed at either an HOPD or a freestanding ASC. Additional patient demographics were collected including age, sex, race and ethnicity (White Non-Hispanic, Black Non-Hispanic, Hispanic, Asian/Pacific Islander Non-Hispanic), insurance status, median household income quartile, urban-rural designation of residence (using National Center for Health Statistics designation schema).…”

“…Patients who underwent OP-ACDF were identified using Current Procedural Terminology (CPT) codes consistent with prior studies 30 . Outpatient procedures were then further categorized as having been performed at either an HOPD or a freestanding ASC.…”

Outpatient Total Ankle Arthroplasty (TAA) as a Rising Alternative to Inpatient TAA: A Database Analysis

“…There are data to suggest that a number of factors affect the location of and access to freestanding ambulatory surgery centers in the United States, and therefore it is reasonable to speculate that these factors may also affect outpatient volumes. 3,14 As for payer type, Medicare policies such as the Inpatient-Only list have a major impact on service location.…”

Recovery Kinetics After Cervical Spine Surgery

“…Both anterior cervical discectomy and fusion (ACDF) and cervical disk replacement (CDR) procedures have been extensively studied for efficacy and safety, and in the appropriate patient population, the two surgeries are effective in improving disability. [3][4][5][6][7] Although safety and efficacy have been established, little research has described the recovery kinetics following these surgeries. This is an especially significant gap in the literature as preoperative counseling is important for patients to understand the postoperative recovery after their procedure.…”