Outcomes of Lumbar Spinal Fusion Are Worse in Black Patients than in White Patients
A study published by Spine suggests that black patients undergoing lumbar spinal fusion surgery have worse outcomes – including higher complication rates, more days in the hospital, and higher costs – when compared with white patients.
“Our study reaffirms the concern than black race remains a social determinant of health impacting equity in surgical outcomes,” according to new research from Robert S. White, MD, MS, of New York Presbyterian Hospital – Weill Cornell Medicine, New York City, and colleagues.
The researchers analyzed discharge records of nearly 268,000 patients who underwent spinal fusion surgery in 5 states – California, Florida, New York, Maryland, and Kentucky – between 2007 and 2014. Most patients were white; only 6.5% were black. Patient characteristics, complication rates, and other outcomes of spinal fusion surgery were compared between white and black racial/ethnic groups.
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Black patients were younger and more likely to be women. They had more health problems, including obesity, diabetes, and high blood pressure. Black patients were also more likely to have low income, to be treated at hospitals that served more “safety net” patients and did a lower volume of spinal fusion surgeries, and to have surgery on an emergency or urgent basis.
Even after adjustment for these differences, black patients had significantly worse outcomes of lumbar spinal fusion than white patients. Black patients were 8% more likely to experience complications specific to spinal surgery and 14% more likely to have general postoperative complications.
Black race/ethnicity was associated with increased odds of hospital readmission at both 30 and 90 days after surgery. Black patients were also more likely to have a longer hospital stay and higher total charges. The racial differences in outcomes remained significant after adjustment for patient demographic factors, co-existing medical conditions, hospital characteristics, and surgical techniques.
There are well-documented disparities in healthcare across a wide range of surgical procedures, including lumbar spinal fusion surgery. “Previous research has identified race as a social determinant of health that impacts outcomes after lumbar spinal fusion surgery,” according to the study authors. Their study examines these associations in a large multistate sample of patients, including a full range of spinal surgery outcomes.
“We showed that black patients, as compared to white patients, are more likely to have postoperative complications, be readmitted, have longer lengths of stay, and have higher total hospital charges,” the study authors wrote. “Our results reaffirm the concern that black race remains a social determinant of health impacting equity in surgical outcomes.”
The racial differences in outcomes might be related to differences in the characteristics of black patients (such as higher rates of diabetes and obesity) or where they are treated (for example, at hospitals that perform a lower volume of spinal fusion procedures). The study authors conclude that, “Hospital systems and providers should adopt methods to promote equity in care, including employee educational programs focusing on healthcare disparities and the impact of unequal care, and through the utilization of standardized protocol based care, such as Enhanced Recovery After Surgery programs, that can reduce the impact of implicit bias on post-surgical outcomes.”
Aladdin DEH, Tangel V, Lui B, Pryor K, Witkin LR, White RS. Black race as a social determinant of health and outcomes after lumbar spinal fusion surgery: a multistate analysis, 2007–2014. Spine; 15 January 2020 [Epub]. doi:10.1097/BRS.0000000000003367.