Racial differences in immediate readmission after transforaminal lumbar interbody fusion

Introduction: Transforaminal lumbar interbody fusions (TLIF) account for most surgical treatments for lumbar spine disease, including degenerative disc disease, disc herniation, stenosis, and spondylolisthesis, in the United States. The literature highlights well-documented racial disparities in long-term outcomes and 90-day readmission rates in spine surgery, yet the severity and timing of early readmissions remain underexplored. This study examines racial disparities within 90 days of TLIF, focusing on early complications or discharge planning issues that may lead to immediate readmissions.

Methods: Using the PINC AI Healthcare database, we identified TLIF patients from January 2016 to September 2022. Readmissions were defined as any inpatient admission within 90 days post-discharge. Readmission50 (the day when 50% of 90-day readmissions is reached) was calculated for each group. Immediate readmission odds (within 10 days) by race were assessed using multivariate logistic regression, adjusting for demographics and clinical factors. ICD10 codes for immediate readmission reasons were categorized by race.

Results: Among 166,417 patients (55.3%Female, 9.7%Black, 53.2%Medicare), 90-day and immediate readmission rates were higher in Black patients (8.3% and 2.9%) than in White patients (6.7% and 2.2%). Readmission50 was similar (17 days for Black patients, 18 days for White). When adjusted for comorbidities and demographics, black patients were at significantly greater odds (OR = 1.23 [1.11,1.36], p < 0.001) of immediate readmission. A statistically significant proportion of black patients experience disruption of surgical wound for immediate readmission: 29.4% (p < 0.001) of immediate readmissions versus 12.2% of overall immediate readmissions. Black patients also had non-statistically significant higher rates of readmission for hematoma, infection, pain, sepsis, and kidney failure.

Conclusion : Racial differences in immediate readmission rates persisted even after adjusting for confounders. We hypothesize that race itself, rather than structural factors correlated with race, has more impact in this short-term, 10-day period. Possible improper surgical site management leading to wound disruption, hematoma, or infection readmission and inadequate pain management leading to acute pain readmission suggest that there are fundamental differences in the quality of care delivered to each race that drives differences in immediate readmission burden. Further study is required to confirm this hypothesis.