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An Inclusive Analysis of Racial Disparities in Lumbar Decompression and Fusion Procedures

Friday, May 3, 2024

    Presenting Author(s)

  • Dillon Putzler, MA

    Student
    University of Hawai'i John A. Burns School of Medicine
    Honolulu, HI, US

    • Co-Author(s)

  • MA

    Maveric Abella, BS

    Student
    University of Hawai'i John A. Burns School of Medicine
    Honolulu, Hawaii, United States

  • DA

    Derek Amanatullah, MD

    Orthopedist
    Stanford University Department of Orthopedic Surgery, United States

  • AF

    Andrea Finlay, PhD

    Statistician
    Stanford University Department of Orthopedic Surgery, United States

  • JH

    Jeffrey Hayashi, BA

    Student
    University of Hawai'i John A. Burns School of Medicine, United States

  • KM

    Kyle Mitsunaga, MD

    Orthopedist
    Queen's Medical Center, United States

Introduction: Adverse outcomes following spinal surgery for African-American populations have been well described. However, outcomes following spinal surgery for other minoritized populations remain inadequately defined. This study aims to identify outcome disparities after lumbar spinal decompression and/or fusion of Hispanic/Latino, Asian, American Indian or Alaskan Native (AI/AN), and Native Hawaiian or Pacific Islander (NH/PI) populations

Methods: The National Surgical Quality Improvement Program was queried to identify all lumbar decompression and/or fusion procedures from 2017 to 2020 (n=113,340). Multivariable regression models were used to investigate the impact of race and ethnicity on 30-day readmission, any medical complication, major and minor medical complications, and reoperation. Secondary outcomes include non-home discharge destination and hospital length of stay.

Results: When adjusted for patient characteristics and compared to white patients, AI/AN patients had higher odds of readmission (AOR: 1.023 (1.003-1.043), p=0.026) and any medical complication (AOR: 1.030, 95% CI: 1.004-1.056, p=0.023), with one adverse outcome every 38 to 131 patients. NH/PI patients had higher odds of readmission (AOR: 1.033, 95% CI: 1.006-1.062), major medical complication (AOR: 1.029, 95% CI: 1.007-1.051), and reoperation (AOR: 1.035, 95% CI: 1.014-1.057), with one adverse outcome for every 31-38 patients. Hispanic/Latino and Asian patients had higher odds of non-home discharge and longer hospital length of stay, but lower odds of medical complications.

Conclusion : Health disparities persist in lumbar spine outcomes, placing AI/AN and NH/PI patients at higher risk for readmission, postoperative medical complication, and reoperation compared to non-Hispanic White patients. Further research is warranted to identify the root causes of these disparities and develop targeted interventions to improve outcomes and reduce disparities in surgical care.