Racial Disparities within Peri- and Postoperative Outcomes for Adolescent Idiopathic Scoliosis Spinal Fusion

Introduction: It has been found that belonging to a different racial group or socioeconomic class affects access to and utilization of medical care. In the context of adolescent idiopathic scoliosis (AIS), these disparities also affect incidence and progression of the condition. Previous studies have examined how race can impact spinal fusion complication rates for AIS amongst Hispanic and Black patient groups. Racial disparities concerning intra- and postoperative care for this condition within Asian American, Native Hawaiian, Pacific Islander, American Indian, and Alaskan Native pediatric patient populations have yet to be assessed.

Methods: The National Surgical Quality Improvement Program Pediatric dataset (NSQIP-P) was queried to identify all spinal fusion procedures from 2015 to 2020 in the National Surgical Quality Improvement Project. Multivariable regression models were used to investigate the impact of race and ethnicity on 30-day outcomes: any complication, readmission, postoperative medical complications, reoperation, and total hospital length of stay.

Results: Compared to non-Hispanic White patients, Asian patients had a 7.0% higher likelihood of experiencing any medical complication (AOR: 1.070 (1.031-1.110), p=0.001), and 7.0% higher chance of a postoperative medical complication (AOR: 1.070 (1.031-1.110), p< 0.001). Native Hawaiian and Pacific Islander patients had a longer length of stay as compared to their non-Hispanic White counterparts (AOR: 9.080 (1.851-44.537), p=0.007). Associations of adverse outcomes between American Indian and Alaska Native patients and White patients were not significant.

Conclusion : Race has been previously studied to examine disparities of care within spinal fusions for pediatric patients with AIS. In addition to Black and Hispanic minority groups, Asians and Native Hawaiian and Pacific Islander patients show to have poorer surgical outcomes compared to their Non-Hispanic White counterparts. We found Asian, AI/AN, and NH/PI populations were more likely to have surgery at an earlier age, longer operative times, more adverse surgical outcomes, and longer post-operative length of stay.