Associate Professor Department of Neurosurgery, University of Pennsylvania Philadelphia, Pennsylvania, United States
Introduction: Race is a social determinant of health that plays a salient role in the access to surgical care. However, few investigations have assessed the impact of race within surgical populations after care has been attained. Our aim was to employ an exact matching protocol among a homogenous population of spine surgery patients, to isolate the relationship between race and short-term postoperative outcomes.
Methods: 4263 consecutive patients undergoing single-level, posterior-only lumbar fusion at a single, multi-hospital, academic medical center were included for analysis. 3406 patients self-identified as white, and 857 patients self-identified as non-white. Outcomes were initially compared between all white patients and all non-white patients via logistic regression. Subsequently, white patients and non-white patients underwent coarsened exact matching; patients were 1:1 matched on key demographic and health characteristics (matched n=1540). Outcomes disparities were evaluated between exact-matched cohorts. Primary outcomes were readmissions, Emergency Department (ED) visits, reoperations, and mortality each assessed within the 30- and 90-day postoperative windows. Additional outcomes included intraoperative complications (e.g., unintentional durotomy) and discharge disposition (home vs. non-home).
Results: Before matching, non-white patients were less likely to be discharged home, and more likely to be readmitted, evaluated in the ED, and undergo reoperation within 30 and 90 days (all p< 0.01). After matching, non-white patients experienced higher rates of non-home discharge (OR 1.96, p< 0.001), as well as 30- and 90-day readmissions (OR 1.61, p=0.003; OR 1.49; p=0.010; respectively) and ED visits (OR 1.57, p=0.030; OR 1.83, p< 0.001). Non-white patients did not have more surgical complications either before or after matching.
Conclusion : Between otherwise similar cohorts of spinal fusion cases, non-white patients experienced unfavorable discharge disposition and a higher risk of multiple adverse postoperative outcomes. However, these findings were not accounted for by differences in surgical complications, suggesting that structural factors underly the observed disparities. Further studies are warranted to employ and evaluate risk-mitigation strategies that support high-risk spine surgery patients.
