Medical Student Vagelos College of Physicians and Surgeons at Columbia University
Introduction: Racial and ethnic health disparities and their impact on access to care and outcomes following cervical spine surgery are of great importance. This study uses the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to show that race and ethnicity (R&E) predict disparities in postoperative complications and access to care for cervical spine surgery.
Methods: Patients who underwent cervical spine surgeries within the ACS-NSQIP database from 2015 to 2020 were analyzed. Demographic, comorbidity, hospital times, and complication data were compared by R&E groups. “Combined occurrences” (wound-related complications, postoperative events, etc.) and hospital times data were analyzed with regressions controlling for demographics and comorbidities.
Results: 53,127 white (78.81%), 8,318 black (12.34%), 4,237 Hispanic (6.29%), and 1,730 Asian (2.57%) patients were analyzed. Black patients experienced rates of smoking (28.93%), diabetes (24.48%), and hypertension (61.71%) significantly more than other R&E groups (p < 0.001). Postoperative complication rates significantly differed among R&E in surgical site infections, unplanned reintubations, urinary tract infections, sepsis, and all combined occurrences (all p≤0.011). Regression analyses revealed that black patients experienced higher respiratory, urinary, cardiovascular, septic complications, and post-operative events compared to white patients (Odds ratio (OR)=1.55, 1.74, 1.45, 1.65, 1.33; all p≤0.0037). Hispanic patients had lower wound complications but higher urinary and septic complications (OR= 0.67, 1.65, 2.33; all p≤0. 033). Asians had lower cardiovascular complications (OR= 0.29; p=0.033). All racial and ethnic groups had significantly longer operative times and total hospital lengths of stay compared to white patients (all p< 0.001).
Conclusion : R&E significantly predicts disparities in postoperative complications and may predict inequities in access to care for cervical spine surgery. Black and Hispanic patients experienced a higher rate of complications compared to white patients, with Asians having a lower rate. Black, Hispanic, and Asian patients were disproportionally underrepresented in this database compared to United States census data. Addressing these disparities through targeted interventions may help bring health equity.