Racial disparities in pediatric spinal fusion surgery affect perioperative outcomes: a national multicenter study

The aim of this study was to evaluate the effect of race and ethnic differences in perioperative outcomes and short-term complications in patients undergoing pediatric spinal fusion surgery.

A retrospective cohort study was performed using prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP-Pediatric) Pediatric database merged with the Pediatric Spinal Fusion Procedure Targeted database from 2016 to 2022 to identify pediatric patients under 18 years who had undergone any spinal fusion procedure for scoliosis using Common Procedural Terminology codes. The study population was divided into four cohorts (1) White (2) Black (3) Asian and (4) Other or Unknown. One-way ANOVA for continuous variables and chi-square tests for categorical variables were used to identify differences in perioperative variables between the four groups. Multivariable logistic regression analysis assessed the effect of race on perioperative surgical and medical complications, extended hospital length of stay, and intensive care unit stay (ICU). Significance was defined as p < 0.05.

A total of 39,666 pediatric spinal fusion patients were identified between 2016 and 2022, of which 25, 521 were White, 6007 were Black, 1342 were Asian, and 6796 were unknown or other. Black and Asian patients experienced significantly higher rates of postoperative medical complications at 75.70 and 74.52%, compared with 69.03% for White patients (p < 0.001). Both Black [OR: 1.383, 95% CI (1.292-1.481)] and Asian [OR: 1.320, 95% CI (1.157-1.509)] patients had an independently increased risk for medical complications, whereas only Black patients had an increased risk for ICU stay [OR: 1.222, 95% CI (1.143-1.306)] complications following a multivariate logistic regression analysis (p < 0.001).

This study provides evidence of racial disparities in outcomes after pediatric spine surgery, even after controlling for demographic and health factors. Pediatric Black and Asian patients undergoing pediatric spinal fusion have a significantly higher risk of postoperative medical complications compared with White patients. These findings emphasize the need to focus on identifying the root cause and ways to reduce racial disparities in pediatric spine surgery. The present study brings awareness to the disparity in the pediatric spine population and is useful as we work towards the reduction in such disparities and their root causes.

Level IV.