The Potential Effect of Racial Disparities on Outcomes After Spine Surgery: A Michigan Spine Surgery Improvement Collaborative (MSSIC) Study

Abstract

Abstract INTRODUCTION Racial disparities have been demonstrated to affect healthcare outcomes over a wide range of disease processes. This goal of this study is to evaluate how race may influence outcomes after elective lumbar spine surgery. METHODS MSSIC was queried for all lumbar operations. Race is a patient reported measure and was stratified into three groups (Caucasian, African-American, others). Demographic information, pre-existing comorbidities, baseline PROs including ODI, NRS, EQ5D, and procedure type (number of levels, fusion) were compared across the three groups. Primary outcome measures were the NASS Patient Satisfaction Index, meeting the MCID for PROs, and return to work at 1 and 2 yr after surgery. Poisson GEE models were done to assess racial differences while adjusting for other patient characteristics. RESULTS A total of 19 191 patients were included in this analysis, 16 788 Caucasian, 1436 African-American, 967 other. Compared to Caucasians, African-Americans had higher proportions of smokers (23% vs 17%), diabetes (32% vs 20%), depression (40% vs 34%), and fusions (56% vs 49%), and greater baseline ODI (55.6 ± 16.0 vs 47.7 ± 16.2). African-American patients had significant associations with dissatisfaction after surgery (RR 1.74 at 1 yr, RR 1.86 at 2 yr), less likely to achieve MCID for ODI (RR 0.87 at 1 yr, RR 0.85 at 2 yr), and less likely to return to work (RR 0.78 at 1 yr, RR 0.82 at 2 yr). After adjusting for baseline factors and postoperative factors (ongoing depression, improvement in PRO, complications) the only significant associations were for patient dissatisfaction (RR 1.36 at 1 yr, RR 1.41 at 2 yr). CONCLUSION Despite significant baseline differences, when adjusting for potential confounding factors, there appears to be an association with race and satisfaction after surgery. Further study into factors to mitigate this disparity are necessary to enhance delivery of care and patient perceptions, regardless of race.