Racial Disparities in Anterior Cervical Discectomy and Fusion: An Analysis of 67621 Patients.

Abstract

Background context: Racial disparities have been demonstrated in the analysis of perioperative outcomes in minority populations in the field of spine surgery when compared to non-minorities. However, there are limited studies investigating the role of racial disparities in cervical spine surgery in a recent, large patient sample.

Purpose: We assessed race and ethnicity as an independent risk factor in outcome disparities following anterior cervical discectomy and fusion (ACDF) among Black or African American (AA), Asian or Pacific Islander (AP), Hispanic (H), and Native American or Alaska Native (NA) patients compared to White or Caucasian (CA) patients.

Study design/setting: A retrospective cohort, large multicenter database study.

Patient sample: The American College of Surgeons National Surgical Quality Improvement Program database was queried for ACDFs from 2011-2021 by Common Procedural Terminology codes (22551, 22552, 22585, and 22554). Patients were categorized into five cohorts based on race and ethnicity: Asian American or Pacific Islander, Black or African American, Hispanic (HA), Native American or Alaskan Native, and White or Caucasian.

Outcome measures: The outcome measures for this study were surgical complications, perioperative, and postoperative outcomes within 30-days postoperative.

Methods: Baseline characteristics were analyzed using analysis of variance (ANOVA) for continuous variables or chi-squared test for categorical variables with Bonferroni correction. Controlling for racial demographic and comorbidity differences via model selection by Akaike information criterion by backward stepwise regression, race and ethnicity were isolated as possible independent risk factors for short-term patient outcomes.

Results: 67,621 patients (54,679 CA, 7358 AA, 1429 AP, 399NA, and 3756 H) were included in this study. AA race was an independent risk factor for medical complications (OR = 1.330, CI = 1.137-1.549, p <0.001), operative time (β = 12.162 minutes, CI = 10.565-13.758, p <0.001), length of stay (β =0.514 days, CI =0.431-0.597, p <0.001), post-operative discharge time (β =0.439 days, CI =0.388-0.491, p <0.001), 30-day reoperation (OR = 1.379, CI = 1.142-1.654, p <0.001), and a non-home discharge destination (OR =2256, CI =2.022-2.514, p <0.001). AP race was an independent risk factor for operative time (β = 14.293 minutes, CI = 10.854-17.732, p <0.001). HA ethnicity was an independent risk factor for a non-home discharge destination (OR= 1.395, CI= 1.171-1.652, p <0.001).

Conclusions: Compared to CA patients, AA, AP, HA, and NA ACDF patients experience greater comorbidity burden and/or unfavorable 30-day surgical outcomes. These findings support the need for the exploration of interdisciplinary care focused on addressing known causes of disparities in minority patients. Future studies should account for social determinants of health by race and ethnicity to identify additional factors that may contribute to higher rates of complications.