Richard Skolasky (Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, USA) and others report in Spine that, following cervical spine surgery, the rate of in-hospital complications (including mortality) is significantly higher in African Americans than it is in Caucasians. However, there is no difference in the rate between Hispanics and Caucasians.
Skolasky et al report that a retrospective review of SPORT (Spine patients outcomes research trial) has already indicated that the rate of functional recovery (in areas such as bodily pain, physical function and disability) is significantly higher at four years in Caucasians than it is in African Americans. They add that the aim of their study was to further explore the influence of race on outcomes after spinal surgery by examining the rate of in-hospital complications and mortality associated with cervical spine surgery. “Our hypothesis was that African Americans and Hispanics would experience more morbidity and mortality than Caucasians, after adjusting for age, sex, household income, insurance status, geographical location, hospital volume, and severity of comorbid conditions,” Skolasky et al comment.
The authors reviewed data from the National Inpatient Sample to identify hospital discharge records that had a primary diagnosis of cervical spine pathology (herniated disc, cervical spondylosis with myelopathy, or cervical stenosis) and at least one cervical spine surgical procedure (anterior fusion, posterior fusion, laminectomy, discectomy, or fusion). Of the 983,420 patients they identified, 86.6% were Caucasian, 8.8% were African American, and 4.6% were Hispanic.
Skolasky et al state: “Overall, African Americans were significantly more likely to have an in-hospital complication than were Caucasians [5.39% vs. 3.9%; p<0.001); there were no differences between Hispanics and Caucasians.” The most common systemic complications were cardiac and respiratory. Also, African Americans had 39% higher odds of having an in-hospital complication than Caucasians and this ratio persisted after adjusting for confounding variables.
There are several potential reasons, according to the authors, for the higher rate of in-hospital complications observed with African Americans. One reason might be the higher rate of comorbid conditions that was observed in the African Americans (in keeping with previous research) compared with Caucasians (0.35 vs. 0.24, respectively; p<0.001). Skolasky et al note: “Future work should examine whether racial and ethnic differences exist in clinical stage at presentation. If such disparity exists, the magnitude of difference should also be documented.” Another potential reason for the difference in the in-hospital complications rate observed with African Americans is that minority populations tend to live in areas with hospitals with a higher rate of complications and/or providers that have lower surgical volume. Furthermore, there may be differences in the cause and progression of cervical spine conditions across different racial and ethical groups. The authors state: “An appreciation of these differences may lead to a better understanding of the potential causes of these observed differences in in-hospital complications and mortality associated with cervical spine surgery.”