TY - JOUR
T1 - Racial Disparities and Surgical Outcomes After Anterior Cervical Discectomy and Fusion
T2 - National Surgical Quality Improvement Program Analysis 2015–2020
AU - Elias, Elias
AU - Smith, Justin
AU - Daoud, Ali
AU - Elias, Charbel
AU - Nasser, Zeina
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/11
Y1 - 2023/11
N2 - Background: Our objective was to assess the effect of race on outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF). Methods: We identified 57,913 adult patients who underwent elective ACDF spine surgery from 2015 to 2020. Data were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Demographics, comorbidities, perioperative course, and 30-day postoperative outcomes were stratified by race. Results: A total of 57,913 patients, white (n = 49,016), African American (AA; n = 7200), Native American (NA; n = 565), and Asian (n = 1132) underwent ACDF fusion surgery. AA patients had higher comorbidities, including diabetes (24.7%), dyspnea (5.9%), and hypertension (61.6%) compared with the other groups (P < 0.001). NA and AA were higher tobacco users, (33.1%) and (28.7%), respectively (P < 0.001). Most of the patients reported in this dataset had single-level surgeries. AAs had a longer average hospital stay (2.51±7.31 days) and operative time (144.13±82.26 min) (P < 0.001). Lower risk of superficial surgical site infection (adjusted odds ratio [ORadj], 0.41; 95% confidence interval [CI], 0.22–0.77; P = 0.005) and greater risk of reintubation (ORadj, 1.65; 95% CI, 1.25–2.17; P < 0.001), pulmonary embolism (ORadj, 1.88; 95% CI, 1.27–2.79; P = 0.001), renal insufficiency (ORadj, 3.15; 95% CI, 1.38–7.20; P = 0.006), and return to the operating room (ORadj, 1.41; 95% CI, 1.18–1.65; P < 0.001 were reported in AAs compared with whites. NAs showed an increased risk of superficial surgical site infection compared with whites (ORadj, 2.59; 95% CI, 1.05–6.36; P = 0.037). Conclusions: Racial disparities were found to independently affect rates of complications after surgery for ACDF.
AB - Background: Our objective was to assess the effect of race on outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF). Methods: We identified 57,913 adult patients who underwent elective ACDF spine surgery from 2015 to 2020. Data were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Demographics, comorbidities, perioperative course, and 30-day postoperative outcomes were stratified by race. Results: A total of 57,913 patients, white (n = 49,016), African American (AA; n = 7200), Native American (NA; n = 565), and Asian (n = 1132) underwent ACDF fusion surgery. AA patients had higher comorbidities, including diabetes (24.7%), dyspnea (5.9%), and hypertension (61.6%) compared with the other groups (P < 0.001). NA and AA were higher tobacco users, (33.1%) and (28.7%), respectively (P < 0.001). Most of the patients reported in this dataset had single-level surgeries. AAs had a longer average hospital stay (2.51±7.31 days) and operative time (144.13±82.26 min) (P < 0.001). Lower risk of superficial surgical site infection (adjusted odds ratio [ORadj], 0.41; 95% confidence interval [CI], 0.22–0.77; P = 0.005) and greater risk of reintubation (ORadj, 1.65; 95% CI, 1.25–2.17; P < 0.001), pulmonary embolism (ORadj, 1.88; 95% CI, 1.27–2.79; P = 0.001), renal insufficiency (ORadj, 3.15; 95% CI, 1.38–7.20; P = 0.006), and return to the operating room (ORadj, 1.41; 95% CI, 1.18–1.65; P < 0.001 were reported in AAs compared with whites. NAs showed an increased risk of superficial surgical site infection compared with whites (ORadj, 2.59; 95% CI, 1.05–6.36; P = 0.037). Conclusions: Racial disparities were found to independently affect rates of complications after surgery for ACDF.
KW - ACDF
KW - Fusion surgery
KW - NSQIP
KW - Race
KW - Surgical outcomes
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U2 - 10.1016/j.wneu.2023.08.097
DO - 10.1016/j.wneu.2023.08.097
M3 - Article
C2 - 37648201
AN - SCOPUS:85171465398
SN - 1878-8750
VL - 179
SP - e380-e386
JO - World neurosurgery
JF - World neurosurgery
ER -