Racial differences in immediate readmission after Multilevel Anterior Cervical Discectomy and Fusion

Introduction: Each year, about 130,000 anterior cervical discectomy and fusion (ACDF) procedures are performed to treat cervical spine conditions, including disc herniations, fractures, and arthritis. The literature highlights well-documented racial disparities in long-term outcomes and 90-day readmission rates, yet the severity and timing of early readmissions remain underexplored. Our study aims to analyze racial disparities in the 90 days following multi-level ACDF, focusing on acute postoperative complications or insufficient discharge planning that may contribute to early readmissions.

Methods: From the PINC AI Healthcare database, a national cross-sectional administrative database, patients who underwent multilevel ACDF between January 2016 and September 2022 were queried. Readmissions were defined as any inpatient admission within 90 days post-discharge. Readmission50, defined as the day at which 50% of readmissions 90-day readmissions were reached for a particular group, was measured. The odds of immediate readmission by race, defined as readmission within 10 days, were measured in a multivariate logistic regression adjusted for Van Walraven Elixhauser score and patient demographics. The frequency of reason for immediate readmission by ICD10 code was tabulated by race.

Results: 155,408 patients (50.8%Female, 12.3%Black, 37.3%Medicare) were included. 90-day and immediate readmission rates are significantly greater in black patients (6.7% and 2.6%) than in white patients (5.5% and 2.0%). Readmission50 was 20% lower in black patients (16 days) versus white patients (20 days). When adjusted for comorbidities and demographics, black patients were at significantly greater odds (OR = 1.15 [1.04,1.28], p = 0.005) of immediate readmission. A disproportionate number of black patients experience dysphagia and unspecified pain on immediate readmission: 19.7% and 23.7% of immediate readmissions for those reasons versus 15.3% of overall immediate readmissions.

Conclusion : The univariate analysis shows significant differences in overall 90-day and immediate readmission rates among racial groups. Even after adjustment in multivariate analysis, racial differences in immediate readmission risk persist. High readmission rates for unspecified pain and dysphagia for black patients indicate differences in the perioperative management of different races. We will further investigate possible racial disparities in utilization of intraoperative neuromonitoring and post-operative pain management that may explain the overrepresentation of black patients in these indications for immediate readmission.