Trends in Outpatient Cervical Spine Surgery: Are There Emerging Disparities?

Area of Science:

• Spine surgery outcomes
• Health equity
• Surgical access disparities

Background:

• Outpatient spine surgery has grown in popularity.
• Racial disparities in surgical utilization are not well understood in outpatient settings.
• Potential restrictive access to outpatient cervical spine procedures exists.

Purpose of the Study:

• Assess racial disparities in outpatient cervical spine surgery utilization between White and Black patients from 2010-2019.
• Analyze the evolution of these racial differences over time.

Main Methods:

• Retrospective cohort study using the National Surgical Quality Improvement Program database (2010-2019).
• Assessed and trended relative utilization of outpatient anterior cervical discectomy and fusion (OP-ACDF) and cervical disk replacement (OP-CDR) between races.
• Used multivariable regressions to adjust for patient factors and comorbidities.

Main Results:

• Black patients were significantly less likely to undergo OP-ACDF or OP-CDR compared to White patients (P <0.03).
• A persistent disparity in outpatient utilization was observed from 2010-2019 for both procedures.
• Adjusted analyses confirmed these persistent racial differences in outpatient cervical spine surgery access.

Conclusions:

• This is the first study to report racial disparities in outpatient spine surgery.
• An emerging disparity in outpatient cervical spine utilization among Black patients was identified.
• Addressing these inequalities in outpatient care is crucial to prevent further entrenchment of disparities in spine surgery delivery.