Impact of Racial/Ethnic Disparities on Patient Reported Outcomes Following Cervical Spine Surgery: QOD Analysis.

STUDY DESIGN

Retrospective analysis of data from the cervical module of a national spine registry, the Quality Outcomes Database (QOD).

OBJECTIVE

To examine the association of race and ethnicity with patient-reported outcome measures (PROMs) at 1 year after cervical spine surgery.

SUMMARY OF BACKGROUND DATA

Evidence suggests that Black individuals are 39% to 44% more likely to have postoperative complications and prolonged length of stay after cervical spine surgery compared to Whites. The long-term recovery assessed with PROMs after cervical spine surgery among Black, Hispanic and other non-Hispanic groups (i.e., Asian) remains unclear.

METHODS

PROMs were used to assess disability (NDI) and neck/arm pain preoperatively and 1-year postoperative. Primary outcomes were disability and pain, and not being satisfied from pre-operative to 12-months after surgery. Multivariable logistic and proportional odds regression analyses were used to determine the association of racial/ethnic groups (Hispanic, non-Hispanic White (NHW), non-Hispanic Black (NHB), and non-Hispanic Asian (NHA)) with outcomes after covariate adjustment and to compute the odds of each racial/ethnic group achieving MCID 1-year postoperatively.

RESULTS

Of the 14,429 participants, all had significant reductions in pain and disability, and 87% were satisfied at 1-year follow-up. Hispanic and NHB patients had higher odds of not being satisfied (40% and 80%) and having worse pain outcomes (30% to 70%) compared to NHW. NHB had 50% higher odds of worse disability scores compared to NHW. NHA reported similar disability and neck pain outcomes compared to NHW.

CONCLUSIONS

Hispanic and non-Hispanic Black patients had worse patient-reported outcomes 1-year after cervical spine surgery compared to non-Hispanic White individuals, even after adjusting for potential confounders, yet there was no difference in disability and neck pain outcomes reported for non-Hispanic Asian patients. This study highlights the need to address inherent racial/ethnic disparities in recovery trajectories following cervical spine surgery.

LEVEL OF EVIDENCE

3.

Informations de copyright

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Déclaration de conflit d'intérêts

Conflicts of Interest and Source of Funding: Dr. Pennings reports personal fees from 3Spine and Steamboat Orthopaedic and Spine Institute. Dr. Coronado was supported by a Vanderbilt Clinical and Translational Research Scholars award (grant number KL2TR002245) during manuscript development. Dr. Brintz was supported by a career development award from the National Center for Complementary and Integrative Health during manuscript development (K23AT011569). Dr. Archer reports personal fees from NeuroSpinal Innovation, Inc and Spine Journal. The other authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. The authors have no personal or institutional financial interest in drugs, materials, or devices described in their submissions.