P90. Racial disparities in surgical access and outcomes for oncologic spinal pathology: a multicenter study

Abstract

BACKGROUND CONTEXT Racial disparities in access to spine surgery and differences in perioperative outcomes have become increasingly evident over the past several years within the United States. However, there is a paucity of evidence concerning racial disparities in surgical access and perioperative outcomes for oncologic spinal pathologies. PURPOSE To determine the association between patient race and access to inpatient spine surgery and perioperative outcomes among patients with oncologic spinal pathologies. STUDY DESIGN/SETTING Retrospective analysis of prospectively collected data. PATIENT SAMPLE The 2010 to 2019 National Surgical Quality Improvement (NSQIP) database was used to identify all black and white patients undergoing surgery for primary or metastatic spine tumors. OUTCOME MEASURES Preoperative health care utilization data including method of hospital admission and rate of emergency surgery were investigated. Postoperative outcomes measures including postoperative length of stay (LOS), 30-day reoperation, 30-day readmission, discharge disposition and major perioperative complications were also investigated. METHODS Patients were stratified by race (black vs white). Two-tailed student t-test was used to analyze continuous data and the Chi Square Test was used to analyze categorical data. A p-value < 0.05 was considered statistically significant. RESULTS A total of 7,320 patients (879 blacks, 6,441 whites) were included in this study. Blacks were more likely to be transferred from an outside emergency room or hospital for definitive care compared to whites (17.3% vs 13.3%; p < 0.01) and a higher rate of emergency surgery was performed among blacks versus whites (14.6% vs 8.2%; p < 0.01). Blacks had a longer post-operative LOS (10.2± 9.2 days vs 7.7 ± 7.4 days; p < 0.01) and higher rates of one or more major perioperative complications (36.8% vs 29.6%; p < 0.01). Blacks also had higher rates of 30-day readmission (14.2% vs 10.4%; p < 0.01) and 30-day re-operation (6.9% vs 4.8%; p < 0.01) as well as higher rates of discharge to a facility (48.2% vs 33.5%). There were no differences in in-hospital mortality rates between blacks and whites (0.8% vs 1.0%; p=0.45). CONCLUSIONS There are significant racial disparities in both access to spine surgery and perioperative outcomes between blacks and whites undergoing surgery for oncologic spinal pathologies. Blacks are more likely to undergo emergency surgery, have longer postoperative LOS, and have higher rates of perioperative complications, 30-day readmission and 30-day reoperation. Renewed efforts to eliminate these disparities are needed on a national level. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Racial disparities in access to spine surgery and differences in perioperative outcomes have become increasingly evident over the past several years within the United States. However, there is a paucity of evidence concerning racial disparities in surgical access and perioperative outcomes for oncologic spinal pathologies. To determine the association between patient race and access to inpatient spine surgery and perioperative outcomes among patients with oncologic spinal pathologies. Retrospective analysis of prospectively collected data. The 2010 to 2019 National Surgical Quality Improvement (NSQIP) database was used to identify all black and white patients undergoing surgery for primary or metastatic spine tumors. Preoperative health care utilization data including method of hospital admission and rate of emergency surgery were investigated. Postoperative outcomes measures including postoperative length of stay (LOS), 30-day reoperation, 30-day readmission, discharge disposition and major perioperative complications were also investigated. Patients were stratified by race (black vs white). Two-tailed student t-test was used to analyze continuous data and the Chi Square Test was used to analyze categorical data. A p-value < 0.05 was considered statistically significant. A total of 7,320 patients (879 blacks, 6,441 whites) were included in this study. Blacks were more likely to be transferred from an outside emergency room or hospital for definitive care compared to whites (17.3% vs 13.3%; p < 0.01) and a higher rate of emergency surgery was performed among blacks versus whites (14.6% vs 8.2%; p < 0.01). Blacks had a longer post-operative LOS (10.2± 9.2 days vs 7.7 ± 7.4 days; p < 0.01) and higher rates of one or more major perioperative complications (36.8% vs 29.6%; p < 0.01). Blacks also had higher rates of 30-day readmission (14.2% vs 10.4%; p < 0.01) and 30-day re-operation (6.9% vs 4.8%; p < 0.01) as well as higher rates of discharge to a facility (48.2% vs 33.5%). There were no differences in in-hospital mortality rates between blacks and whites (0.8% vs 1.0%; p=0.45). There are significant racial disparities in both access to spine surgery and perioperative outcomes between blacks and whites undergoing surgery for oncologic spinal pathologies. Blacks are more likely to undergo emergency surgery, have longer postoperative LOS, and have higher rates of perioperative complications, 30-day readmission and 30-day reoperation. Renewed efforts to eliminate these disparities are needed on a national level.