脊柱手术患者资源利用和预后的种族/民族差异：402,765例患者的NSQIP分析

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-05-02 DOI:10.1016/j.clineuro.2025.108931

Aladine A. Elsamadicy , Paul Serrato , Shaila D. Ghanekar , Sina Sadeghzadeh , Justice Hansen , Lucas P. Mitre , Sheng-fu Larry Lo , Daniel M. Sciubba

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引用次数: 0

摘要

目的本研究旨在评估种族/民族对脊柱手术患者术后不良事件（ae）、延长住院时间（LOS）、非常规出院（NRD）和意外再入院的影响。方法采用2016-2023年ACS NSQIP数据库进行回顾性队列研究。使用CPT代码识别因创伤、退行性疾病、肿瘤和感染性原因接受脊柱手术的成年人，并根据种族/民族进行分层。主要分类包括非西班牙裔白人、非西班牙裔黑人、非西班牙裔亚裔和西班牙裔患者。评估患者人口统计学、合并症、术中变量、术后ae和医疗资源利用情况。多因素logistic回归分析用于确定ae、延长的LOS、NRD和计划外入院的预测因素。结果在我们的402,765例患者队列中，ae的术后结果显示出显著的种族差异，其中非西班牙裔黑人发生率最高（p <； 0.001）。同样，非西班牙裔黑人的手术时间延长，意外再入院和再手术率增加（p均为 <； 0.001）。多因素分析显示，非西班牙裔黑人发生延长的LOS （aOR: 1.83, 95 % CI: 1.78-1.88, p <； 0.001）和ae （aOR: 1.10, 95 % CI: 1.06-1.15, p <； 0.001）的风险增加。非西班牙裔黑人(优势比:1.84,95 % CI: 1.78 - -1.90, p & lt; 0.001),非西班牙裔的亚洲人(优势比:1.14,95 % CI: 1.07 - -1.21, p & lt; 0.001),和西班牙裔(优势比:1.48,95 % CI: 1.43 - -1.54, p & lt; 0.001)有更高的可能性”。对于计划外再入院，非西班牙裔黑人（aOR: 1.13, 95 % CI: 1.08-1.19, p <； 0.001）的几率增加，而非西班牙裔亚洲人的几率降低（aOR: 0.80, 95 % CI: 0.72-0.90, p <； 0.001）。结论：我们的研究表明脊柱手术患者术后结果存在明显的种族差异，非西班牙裔黑人患者的风险尤其高。

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Racial/ethnic disparities on resource utilization and outcomes for patients undergoing spine surgery: A NSQIP analysis of 402,765 patients

Objective

This study aimed to evaluate the impact of race/ethnicity on postoperative adverse events (AEs), prolonged length of stay (LOS), non-routine discharge (NRD), and unplanned readmission in spine surgery patients.

Methods

A retrospective cohort study was performed using the 2016–2023 ACS NSQIP database. Adults receiving spine surgery for trauma, degenerative disease, tumor, and infectious causes were identified using CPT codes and stratified based on race/ethnicity. The primary categories included Non-Hispanic White, Non-Hispanic Black, Non-Hispanic Asian, and Hispanic patients. Patient demographics, comorbidities, intraoperative variables, postoperative AEs, and healthcare resource utilization were assessed. Multivariate logistic regression analysis was utilized to identify predictors of AEs, prolonged LOS, NRD, and unplanned admission.

Results

In our cohort of 402,765 patients, postoperative outcomes displayed significant ethnic disparities in AEs, with the highest in Non-Hispanic Blacks (p < 0.001). Similarly, Non-Hispanic Blacks had prolonged operation times and increased rates of unplanned readmissions and reoperations (all p < 0.001). Multivariate analysis showed Non-Hispanic Blacks had an increased risk for extended LOS (aOR: 1.83, 95 % CI: 1.78–1.88, p < 0.001) and AEs (aOR: 1.10, 95 % CI: 1.06–1.15, p < 0.001). Non-Hispanic Blacks (aOR: 1.84, 95 % CI: 1.78–1.90, p < 0.001), Non-Hispanic Asians (aOR: 1.14, 95 % CI: 1.07–1.21, p < 0.001), and Hispanics (aOR: 1.48, 95 % CI: 1.43–1.54, p < 0.001) had higher odds of NRD. For unplanned readmissions, Non-Hispanic Blacks (aOR: 1.13, 95 % CI: 1.08–1.19, p < 0.001) had increased odds, while Non-Hispanic Asians showed decreased odds (aOR: 0.80, 95 % CI: 0.72–0.90, p < 0.001).

Conclusion

Our study demonstrates prominent racial/ethnic disparities in postoperative outcomes among spine surgery patients, with particularly elevated risks observed in Non-Hispanic Black individuals.

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.