99. Racial disparities in spine surgery: a systematic review

Abstract

<h3>BACKGROUND CONTEXT</h3> Racial disparities in access, outcomes, and quality of health care have been increasingly substantiated by research over the last few decades. Inequities based on race and ethnicity can be found across multiple surgical subspecialties. Despite increased efforts to mitigate racial bias, disparities persist, including in the field of spine surgery. <h3>PURPOSE</h3> To synthesize previous studies evaluating racial disparities in spine surgery. <h3>STUDY DESIGN/SETTING</h3> Systematic review. <h3>PATIENT SAMPLE</h3> Patients found in the literature on racial disparities in spine surgery. <h3>OUTCOME MEASURES</h3> The main outcome measures were the occurrence of racial disparities in postoperative outcomes, mortality, surgical management, readmissions and length of stay. <h3>METHODS</h3> We queried PubMed, Embase, Cochrane Library, and Web of Science for literature on racial disparities in spine surgery. Our review was constructed in accordance with Preferred Reporting Items and Meta-analyses (PRISMA) guidelines and protocol. <h3>RESULTS</h3> A total of 1,753 publications were assessed. Twenty-two articles met inclusion criteria. Seventeen studies compared Caucasians (CAs) and African Americans (AAs) groups; fourteen studies reported adverse outcomes for AAs. When compared to CAs, AA patients had higher odds of postoperative complications including mortality, cerebrospinal fluid leak, nervous system complications, bleeding, infection, in-hospital complications, adverse discharge disposition and delay in diagnosis. Further, AAs were found to have increased odds of readmission and longer length of stay. Finally, AAs were found to have higher odds of nonoperative treatment for spinal cord injury, were more likely to undergo posterior approach in the treatment of cervical spondylotic myelopathy and were less likely to receive cervical disc arthroplasty compared to CAs for similar indications. <h3>CONCLUSIONS</h3> This systematic review of spine literature found that when compared to CA patients, AA patients had worse health outcomes. Further investigation of root causes of these racial disparities in spine surgery is warranted. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.