The Impact of Race and Ethnicity on Post-operative Complications Following Spine Surgery: Results from the National Surgical Quality Improvement Program

Introduction: Racial and ethnic health disparities and their impact on outcomes are of great interest following spine surgery. This study uses the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to show that race and ethnicity (R&E) independently predict postoperative complications following spine surgery.

Methods: Patients who underwent spine surgery within the ACS-NSQIP database from 2015 to 2020 were analyzed. Demographic, comorbidity, hospital times, and complication data were compared by R&E using univariate analyses. “Combined occurrences” (wound-related complications, postoperative events, etc.) and hospital times data were analyzed with regressions controlling for demographics and comorbidities.

Results: 181,913 white, 21,501 black, 10,710 Hispanic, 5,611 Asian, 1,249 Native American (NA), and 628 Native Hawaiian (NH) patients were analyzed. Black patients experienced rates of dyspnea (4.86%), diabetes (24.95%), and hypertension (63.49%) significantly more than other R&E groups (p < 0.001). Postoperative complication rates significantly differed among R&E groups in surgical site infections, pulmonary embolisms, renal insufficiency, cardiac arrests, and all combined occurrences (all p≤0.02). Regression analyses revealed that black patients experienced higher wound, respiratory, urinary, cardiovascular, septic complications, and post-operative events compared to white patients (Odds ratio (OR)=1.55, 1.35, 1.32, 1.29, 1.22; all p≤0.0072). Hispanic patients had lower wound complications but higher urinary complications and post-operative events (OR= 0.82, 1.23, 1.11; all p≤0.041). Asians had lower respiratory, cardiovascular complications, and post-operative events (OR= 0.66, 0.65, 0.79; all p≤0.030). NA had higher rates of wound, septic complications, and post-operative events (OR=1.88, 1.96, 1.29; all p≤0.033). No significant differences were found in regression analyses for NH patients, but 4/6 combined occurrences had higher odds than white patients.

Conclusion : R&E significantly predicts disparities in postoperative complications following spine surgery. Black, Hispanic, and NA patients experienced a higher rate of complications compared to white patients, whereas Asian patients experienced a lower rate. Addressing these disparities through targeted interventions may help bring health equity.