Association Between Race/Ethnicity and Spinal Fusion Outcomes in a Managed Health-Care Model

Area of Science:

• Health Services Research
• Surgical Outcomes
• Health Disparities

Background:

• Race, ethnicity, and insurance status are known drivers of healthcare disparities.
• Limited research exists on disparities within managed care models like Kaiser Permanente (KP).
• KP offers integrated care with equal access for all beneficiaries, making it a unique setting to study disparities.

Purpose of the Study:

• To investigate healthcare disparities in spinal fusion outcomes among patients within a managed care system.
• To determine if racial and ethnic differences exist in reoperations, emergency department visits, readmissions, and mortality after spinal fusion at KP.

Main Methods:

• Retrospective cohort study using data from the KP Spine Registry (n=40,258).
• Analysis of spinal fusion outcomes based on race/ethnicity (White, Black, Hispanic, Asian).
• Outcomes included reoperations, 90-day emergency department visits, 90-day readmissions, and 90-day/1-year mortality, adjusted for confounders.

Main Results:

• Lower reoperation risk observed for Black, Hispanic, and Asian patients compared to White patients.
• Black and Hispanic patients had a higher likelihood of 90-day emergency department visits.
• Black patients showed a higher likelihood of 90-day readmissions; no significant mortality differences were found.

Conclusions:

• Healthcare disparities persist among Black and Hispanic patients undergoing spinal fusion, even within a managed care system like KP.
• Managed care networks may reduce disparities compared to other systems, but further efforts are needed for equitable outcomes.
• Urgent need for continued research to address and eliminate identified disparities in spinal fusion care.