Abstract
BACKGROUND CONTEXT In spine surgery, racial disparities have been shown to impact various aspects of surgical care. Previous studies have associated racial disparities with inferior surgical outcomes, including increased complication and 30-day readmission rates after spine surgery. Recently, patient reported outcomes (PROs) and satisfaction measures have been proxies for overall quality of care and hospital reimbursements. However, the influence racial disparities have on short- and long-term PROs and satisfaction after spine surgery is relatively unknown. PURPOSE The aim of this study was to investigate the impact racial disparities have on three-month and one-year PROs and satisfaction after elective lumbar spine surgery. STUDY DESIGN/SETTING This was a retrospectively analyzed study from a maintained prospective database. PATIENT SAMPLE The medical records of 345 adult (≥18years old) patients who underwent elective lumbar spine surgery for spondylisthesis (Grade 1), disc herniation, or stenosis at a major academic institution. OUTCOME MEASURES Patient reported outcomes instruments (ODI, VAS-Back Pain, and VAS Leg-Pain) were completed before surgery, then at 3- and 12-months after surgery along with patient satisfaction measures. METHODS This was a retrospectively analyzed study from a maintained prospective database. The medical records of 345 adult (≥18years old) patients who underwent elective lumbar spine surgery for spondylisthesis (Grade 1), disc herniation, or stenosis at a major academic institution were included in this study. We identified 53 (15.4%) African-American patients and 292 (84.6%) Caucasian patients. Patient demographics, comorbidities, postoperative complication and 30-day readmission rates were collected. Patients had prospectively collected outcome and satisfaction measures. Patient reported outcomes instruments (ODI, VAS-Back Pain, and VAS Leg-Pain) were completed before surgery, then at 3 and 12 months after surgery along with patient satisfaction measures. RESULTS Baseline patient demographics and comorbidities were similar between both cohorts, with AA patients having increased BMI (33.1±6.6 kg/m2 vs. 30.2±6.4 kg/m2, p=.0005) and diabetes (35.9% vs. 16.1%, p=.0008). Surgical indications, operative variables, and postoperative variables were similar between both cohorts. Baseline and follow-up PRO measures were worse in the AA cohort, with patients having a greater ODI (p CONCLUSIONS Our study suggests that there is a significant difference in perception of health, pain and disability between African-American and Caucasian patients at baseline, short- and long-term follow up which may influence overall patient satisfaction. Further studies are necessary to identify patient specific factors associated with racial disparities that may be influencing outcomes in order to adequately measure and assess overall PROs and satisfaction after elective lumbar spine surgery.
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