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Complications and mortality in cervical spine surgery: racial differences
Richard L Skolasky1, Roland J Thorpe, Stephen T Wegener
1*Orthopaedic Surgery †Health Behavior and Society and Hopkins Center for Health Disparities Solutions, and ‡Physical Medicine and Rehabilitation, The Johns Hopkins University, Baltimore, MD.
Spine
|May 27, 2014
Summary
African Americans experienced higher in-hospital complication and mortality rates after cervical spine surgery compared to Caucasians. These disparities in surgical outcomes persisted even after accounting for other risk factors.
Area of Science:
- Orthopedic Surgery
- Health Disparities
- Spine Surgery Outcomes
Background:
- Racial and ethnic disparities in orthopedic spine care are not well understood regarding their impact on morbidity and mortality.
- The specific effects of race and ethnicity on outcomes following cervical spine surgery require further investigation.
Purpose of the Study:
- To estimate racial and ethnic differences in in-hospital complication and mortality rates associated with cervical spine surgery.
- To analyze the association between race/ethnicity and adverse outcomes in patients undergoing cervical spine procedures.
Main Methods:
- Retrospective analysis of a national database (Nationwide Inpatient Sample) from 2000-2009.
- Inclusion of 983,420 adult, non-trauma hospital discharges undergoing cervical spine surgery.
- Multivariable regression models used to assess race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic) as the primary independent variable, adjusting for covariates like age, sex, income, insurance, hospital volume, and comorbidities.
Main Results:
- Overall in-hospital complication and mortality rates were 4.09% and 0.42%, respectively.
- No significant differences in complication or mortality rates were observed between Hispanic and Caucasian patients.
- African Americans demonstrated significantly higher odds of in-hospital complications (OR, 1.37) and mortality (OR, 1.59) compared to Caucasians.
Conclusions:
- African Americans face significantly higher rates of in-hospital complications and mortality following cervical spine surgery compared to Caucasians.
- These observed racial disparities in surgical outcomes remain significant even after adjusting for known risk factors.
- Findings highlight the need to address persistent racial inequalities in cervical spine surgery care and outcomes.
