Why the study?
The impact of race on post-operative outcomes and complications following elective spine surgery in the United States needed evaluation.
Does African American race increase the risk of perioperative complications, readmissions, and mortality after elective spine surgery in the United States compared to White race?
Does African American race increase the risk of perioperative complications, readmissions, and mortality after elective spine surgery in the United States compared to White race?
African American patients face a significantly greater risk of morbidity and mortality across several categories of peri-operative events following elective spine surgery compared to White patients.
Elective spine surgery carries higher risks for African American patients; extends disparity evidence but leaves causal mechanisms and interventions open.
Study Design Systematic Review and Meta-analysis. Objectives To evaluate the impact of race on post-operative outcomes and complications following elective spine surgery in the United States. Methods PUBMED, MEDLINE(R), ERIC, EMBASE, and SCOPUS were searched for studies documenting peri-operative events for White and African American (AA) patients following elective spine surgery. Pooled odds ratios were calculated for each 90-day outcome and meta-analyses were performed for 4 peri-operative events and 7 complication categories. Sub-analyses were performed for each outcome on single institution (SI) studies and works that included <100,000 patients. Results 53 studies (5,589,069 patients, 9.8% AA) were included. Eleven included >100,000 patients. AA patients had increased rates of 90-day readmission (OR 1.33, P = .0001), non-routine discharge (OR 1.71, P = .0001), and mortality (OR 1.66, P = .0003), but not re-operation (OR 1.16, P = .1354). AA patients were more likely to have wound-related complications (OR 1.47, P = .0001) or medical complications (OR 1.35, P = .0006), specifically cardiovascular (OR 1.33, P = .0126), deep vein thrombosis/pulmonary embolism (DVT/PE) (OR 2.22, P = .0188) and genitourinary events (OR 1.17, P = .0343). SI studies could only detect racial differences in re-admissions and non-routine discharges. Studies with <100,000 patients replicated the above findings but found no differences in cardiovascular complications. Disparities in mortality were only detected when all studies were included. Conclusions AA patients faced a greater risk of morbidity across several distinct categories of peri-operative events. SI studies can be underpowered to detect more granular complication types (genitourinary, DVT/PE). Rare events, such as mortality, require larger sample sizes to identify significant racial disparities.
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Akosman et al. (2023) studied this question.
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