Predictors of Nonelective Surgery for Spinal Metastases: Insights from a National Database. Issue 24 (15th December 2021)

• Record Type: Journal Article
• Authors: Khan, Hammad A.; Rabah, Nicholas M.; Chakravarthy, Vikram; Tripathi, Raghav; Krishnaney, Ajit A.
• Is Part Of: Spine. Volume 46:Issue 24(2021)
• Page Start: E1334
• Page End: E1342
• Publication Date: 2021-12-15
• Subjects: health care disparities -- National inpatient sample -- nonelective surgery -- spine metastases; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000004109
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Non-elective surgery for spine tumors is associated with poor postoperative outcomes. Using a national all-payer database, we demonstrate substantial sociodemographic disparities in the receipt of non-elective versus elective surgery for spinal metastases and thereby elucidate patient populations that may serve as the focus of interventions to reduce disparities in care. Abstract : Study Design: Secondary analysis of a national all-payer database. Objective: Our objectives were to identify patient- and hospital-level factors independently associated with the receipt of nonelective surgery and determine whether nonelective surgery portends differences in perioperative outcomes compared to elective surgery for spinal metastases. Summary of Background Data: Spinal metastases may progress to symptomatic epidural spinal cord compression that warrants urgent surgical intervention. Although nonelective surgery for spinal metastases has been associated with poor postoperative outcomes, literature evaluating disparities in the receipt of nonelective versus elective surgery in this population is lacking. Methods: The National Inpatient Sample (2012–2015) was queried for patients who underwent surgical intervention for spinal metastases. Multivariable logistic regression models were constructed to evaluate the association of patient- and hospital-level factors with the receipt of nonelective surgery, as well as to evaluate the influence of admission status on perioperative outcomes. Results: After adjusting for disease-related factors and other baseline covariates, our multivariable logistic regression model revealed several sociodemographic differences in the receipt of nonelective surgery. Patients of black (odds ratio [OR] = 1.38, 95% confidence interval [CI]: 1.03–1.84, P = 0.032) and other race (OR = 1.50, 95% CI: 1.13–1.98, P = 0.005) had greater odds of undergoing nonelective surgery than their white counterparts. Patients of lower income (OR = 1.40, 95% CI: 1.06–1.84, P = 0.019) and public insurance status (OR = 1.56, 95% CI: 1.26–1.93, P < 0.001) were more likely to receive nonelective surgery than higher income and privately insured patients, respectively. Higher comorbidity burden was also associated with greater odds of non-elective admission (OR = 2.94, 95% CI: 2.07–4.16, P < 0.001). With respect to perioperative outcomes, multivariable analysis revealed that patients receiving nonelective surgery were more likely to experience nonroutine discharge (OR = 2.50, 95% CI: 2.09–2.98, P < 0.001) and extended length of stay [LOS] (OR = 2.45, 95% CI: 1.91–3.16, P < 0.001). Conclusion: The present study demonstrates substantial disparities in the receipt of nonelective surgery across sociodemographic groups and highlights its association with nonroutine discharge and extended LOS. Level of Evidence: 3