Racial and Ethnic Health Disparities Following Spine Surgery: ACS-NSQIP Review From 2015 to 2020

Study Design Retrospective Analysis. Objective The National Surgical Quality Improvement Program (NSQIP) database was used to determine whether race and ethnicity (R&E) are independent predictors of postoperative complications following spine surgery. Methods Demographic, comorbidity, and complication data were compared by R&E using chi-square and Kruskal-Wallis tests. Complications and postoperative categorical variables were combined and compared with logistic regression by R&E. Hospital times data was compared with both Kruskal-Wallis and linear regression. Regressions all controlled for age, weight, sex, and comorbidities. All R&E groups were compared to White patients. Results 181,913 White, 21,501 Black, 10,710 Hispanic, 5611 Asian, 1249 Native American (NA), and 628 Native Hawaiian (NH) patients were in our analysis. Black patients experienced the highest rates of dyspnea (4.86%), diabetes (24.95%), and hypertension (63.49%), which was significantly different from the other groups (all P < 0.0001). Regression analyses revealed that Black patients experienced higher respiratory, urinary, cardiovascular, septic complications, and postoperative events compared to White patients (Odds ratio (OR) = 1.55, 1.35, 1.32, 1.29, 1.22; all P ≤ 0.0072). Hispanic patients had lower wound complications but higher urinary complications and postoperative events (OR = 0.82, 1.23, 1.11; all P ≤ 0.041). Asians had lower respiratory, cardiovascular complications, and postoperative events (OR = 0.66, 0.65, 0.79; all P ≤ 0.030). Native Americans had higher rates of wound, septic complications, and postoperative events (OR = 1.88, 1.96, 1.29; all P ≤ 0.033). Conclusions R&E predicts postoperative complication disparities following spine surgery. Black, Hispanic, and Native American patients have higher odds of complications. Targeted interventions focusing on perioperative care are needed to improve health equity.