National Utilization and Inpatient Safety Measures of Lumbar Spinal Fusion Methods by Race/Ethnicity

Background context: Degenerative lumbar conditions are prevalent, disabling, and frequently managed with decompression and fusion. Black patients have lower spinal fusion rates than White patients.

Purpose: Determine whether specific lumbar fusion procedure utilization differs by race/ethnicity and whether length of stay or inpatient complications differ by race/ethnicity after accounting for procedure performed.

Study design: Large database retrospective cohort study PATIENT SAMPLE: Lumbar fusion recipients at least age 50 in the 2016 National Inpatient Sample with diagnoses of degenerative lumbar conditions.

Outcome measures: Type of fusion procedure used and inpatient safety measures including length of stay (LOS), prolonged LOS, inpatient medical and surgical complications, mortality, and cost.

Methods: We examined the association between race/ethnicity and the safety measures above. Covariates included several patient and hospital factors. We used multiple linear or logistic regression to determine the association between race and fusion type [PLF, P/TLIF, ALIF, PLF + P/TLIF, and PLF + ALIF (anterior-posterior fusion)] and to determine whether race was associated independently with inpatient safety measures, after adjustment for patient and hospital factors.

Results: Fusion method use did not differ among racial/ethnic groups, except for somewhat lower anterior-posterior fusion utilization in Black patients compared to White patients [crude OR: 0.81 (0.67-0.97)]. Inpatient safety measures differed by race/ethnicity for rates of prolonged LOS (Blacks 18.1%, Hispanics 14.5%, Whites 11.7%), medical complications (Blacks 9.9%, Hispanics 8.7%, Whites 7.7%), and surgical complications (Blacks 5.2%, Hispanics 6.9%, Whites 5.4%). Differences persisted after adjustment for procedure type as well as patient and hospital factors. Blacks and Hispanics had higher risk for prolonged LOS compared to Whites [adjusted OR Blacks 1.39 (95% CI 1.22-1.59); Hispanics 1.24 (95% CI 1.02-1.52)]. Blacks had higher risk for inpatient medical complications compared to Whites [adjusted OR 1.24 (95% CI 1.05-1.48)], and Hispanics had higher risk for inpatient surgical complications compared to Whites [adjusted OR 1.34 (95% CI 1.06-1.68)].

Conclusions: Fusion method use was generally similar between racial/ethnic groups. Inpatient safety measures, adjusted for procedure type, patient and hospital factors, were worse for Blacks and Hispanics.

Keywords: Disparities; Ethnicity; Lumbar Spinal Fusion; National Inpatient Sample; Race.