45. Association of race with early outcomes of elective posterior spinal fusion for adolescent idiopathic scoliosis: A propensity score matched analysis

Abstract

<h3>BACKGROUND CONTEXT</h3> Existing literature demonstrates well-identified racial disparities in spine surgery outcomes. However, previous studies are of significant limitations. <h3>PURPOSE</h3> To investigate the association of race with 30-day perioperative complication rates of elective posterior spinal fusions (PSF) for adolescent idiopathic scoliosis (AIS). <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> All pediatric patients with AIS who underwent PSF between 2012-2018 were reviewed from the (ACS-NSQIP) pediatric database. <h3>OUTCOME MEASURES</h3> Thirty-day postoperative morbidity and mortality outcomes were analyzed. Complications included perioperative blood transfusion, venous thromboembolism, unplanned intubation, pneumonia, urinary tract infection, surgical site infection, sepsis, return to operating room, and death. Hospital course data, including operative time, the total length of hospital stay, the proportion of patients needed ICU admission, the proportion of patients discharged to other than home and discharged after the 4th postoperative day were also noted. Readmission data was included. These outcome variables are predefined in the ACS-NSQIP pediatric database, except for the discharge event after the 4th postoperative day, which was considered to be any discharge event occurring after a total hospital stay of 120 hours. <h3>METHODS</h3> Propensity score matching was used to determine whether race (ie, black vs white) had an influence on 30-day perioperative complications. <h3>RESULTS</h3> A total of 4,051 PSF for AIS cases met inclusion criteria and were reviewed. Of these, 3221 (79.5%) patients were white and 830 (20.5%) were black. Patients in the black cohort were more likely to have higher BMI (23.8 vs 21.1), be of female gender (78.2% vs 74.5%), have an ASA class 3 or more (13.7% vs 11.1%), have asthma (8.3% vs 4.9%), have cardiac risk factors (5.1% vs 2.6%), use steroids (3.8% vs 1.1%). In the black cohort, 8% of the cases had up to 6 vertebral segments fused, 64.4% had 7-12 vertebral segments fused and 27.6% had 13 or more vertebral segments fused. In the white cohort, 15.9% of the cases had up 6 vertebral segments fused, 57.2% had 7-12 vertebral segments fused and 26.9% had 13 or more vertebral segments fused. After controlling for differences in baseline factors, except for the higher incidence of venous thromboembolism in the black cohort (2.8% vs 0.1%), (p <0.001), there were no significant differences in morbidity and mortality between the black and white cohorts. <h3>CONCLUSIONS</h3> In contrast to prior literature, our analysis did not identify black race as an independent risk factor for higher perioperative morbidity or mortality in patients undergoing PSF for AIS, except for the higher incidence of venous thromboembolism. We believe that these results are important findings for clinicians and spine surgeons while counseling patients undergoing these types of procedures. It is important to address patient's concerns and to explain that the previously reported inferior perioperative morbidity and mortality outcomes in black patients might be due differences in baseline health status, and not due to the race difference itself. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.