Racial disparities in health care is not a new phenomenon, the researchers acknowledged: “Racial disparities in healthcare have been demonstrated across a range of surgical procedures. Previous research has identified race as a social determinant of health that impacts outcomes after lumbar spinal fusion surgery. However, these studies are limited in that they are outdated, contain data from a single institution, analyze small limited samples, and report limited outcomes.”
Therefore, they stated, “Our study aims to expand and update the literature examining the association between race and inpatient post-operative complications following lumbar spine surgery.”
The team conducted a retrospective analysis of 267,976 patient discharge records for inpatient lumbar spine surgery performed between 2007 and 2014. Data were gathered from the Healthcare Cost and Utilization Project’s State Inpatient Databases for California, Florida, New York, Maryland, and Kentucky. Variables including patient demographics, present-on-admission comorbidities, hospital characteristics, and complications were compared by race.
Complications, Readmissions, Higher for Black Spine Surgery Patients
Black patients, compared to white patients, were 8% more likely to sustain spine surgery specific complications (adjusted odds ratio [aOR]=1.08; 95% confidence interval [CI], 1.03–1.13) and general postoperative complications (aOR=1.14; 95% CI, 1.07–1.20). Black patients were also more likely to experience 30-day readmissions (aOR=1.13; 95% CI, 1.07–1.20) and 90-day readmissions (aOR=1.07; 95% CI, 1.02–1.13), as well as longer length of stay and higher total charges.
When it comes to spine surgery, “We showed that black patients, as compared to white patients, are more likely to have postoperative complications, be readmitted, have longer lengths of stay, and have higher total hospital charges,” wrote the study authors. “Our results reaffirm the concern that black race remains a social determinant of health impacting equity in surgical outcomes.”
In looking to address these disparities, the authors recommended: “Hospital systems and providers should adopt methods to promote equity in care, including employee educational programs focusing on healthcare disparities and the impact of unequal care, and through the utilization of standardized protocol based care, such as Enhanced Recovery After Surgery programs, that can reduce the impact of implicit bias on post-surgical outcomes.”