Medical Student Perelman School of Medicine Philadelphia, Pennsylvania, United States
Disclosure(s):
Austin J. Borja: No financial relationships to disclose
Introduction: Race has implications for access to medical care. However, the impact of race, after access to care has been attained, remains poorly understood. Our objective was to isolate race from outcome-mitigating factors, and to singularly assess the relationship between race and short-term outcomes across otherwise exact-matched patients undergoing a single, common neurosurgical procedure.
Methods: In this IRB-approved retrospective study, 3988 consecutive patients undergoing single-level, posterior-only lumbar fusion at a single, multi-hospital, university medical system were prospectively enrolled over a six-year period. 3406 patients self-identified as white, and 582 patients self-identified as black. First, outcome disparities between all white patients versus all black patients were estimated using logistic regression. Subsequently, coarsened exact matching was used to control for outcome-mitigating factors unrelated to race; white and black patients were exact-matched 1:1 on key baseline demographic and health characteristics (matched n=1018). Outcomes were compared between matched cohorts. Primary outcomes included intraoperative complications (e.g., unintentional durotomy); discharge disposition; and readmissions, Emergency Department (ED) visits, reoperations, and mortality each assessed at 30 and 90 days.
Results: Prior to matching, black patients were observed to experience increased rate of non-home discharge, as well as 30- and 90-day readmissions, ED visits, and reoperations (all p< 0.001). After exact matching, black patients were less likely to be discharged to home (OR 2.68, p< 0.001) and had higher risk of 30- and 90-day readmissions (OR 2.24, p< 0.001; OR 1.91, p< 0.001; respectively) and ED visits (OR 1.79, p=0.017; OR 2.09, p< 0.001). Black patients did not experience greater risk of surgical complications before or after matching.
Conclusion : Between otherwise homogenous cohorts, black patients experienced unfavorable short-term outcomes in the setting of spinal fusion. These observed disparities were not explained by differences in intraoperative complications. Further investigation must characterize and mitigate the institutional and societal factors that contribute to outcome disparities.
