Portending Influence Racial Disparities has on Extended Length of Stay after Elective Anterior Cervical Discectomy and Interbody Fusion for Cervical Spondylotic Myelopathy. (16th November 2020)

• Record Type: Journal Article
• Authors: Elsamadicy, Aladine A; Koo, Andrew B; David, Wyatt; Sarkozy, Margot; Freedman, Isaac G; Reeves, Benjamin; Laurans, Maxwell; Kolb, Luis; Sciubba, Daniel M
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_194
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Despite recent progress towards equitable and unbiased healthcare delivery, previous studies exploring anterior cervical discectomy and fusion (ACDF) outcomes have found disparate rates in complications and mortality. However, there is a paucity of data focusing on the impact that race has on extended hospital length of stay (LOS) after ACDF for cervical spondylotic myelopathy (CSM). METHODS: A retrospective cohort study was performed using the National Inpatient Sample (NIS) database from 2016 and 2017. All adult patients undergoing primary, anterior cervical discectomy and interbody fusion for CSM were identified. Patients were dichotomized according to their race: African-American/Black and Caucasian/White. A multivariate stepwise logistic regression was used to determine the odds ratio for risk-adjusted extended LOS. RESULTS: A total of 15, 400 patients were identified, of which 13, 250 (86.0%) were Caucasian (C) and 2, 150 (14.0%) were African-American (AA). The Caucasian cohort tended to be older, while the African-American cohort had more than 2-times greater proportion of patients in the 0–25 th income quartile (C: 23.3% vs. AA: 47.0%, P < . 001). The prevalence of comorbidities was greater in the African-American cohort. Intraoperative fusion levels were similar between the cohorts, while the African-American cohort had a higher rate of cerebrospinal fluid leak/dural tear C: 0.3% vs. AA: 1.2%, P = . 010). In relation to the number of complications, the Caucasian cohort had a lower rate compared to African-American cohort ( P = . 006), including no complication (89.4% vs 85.3%), 1 complication: (9.9% vs 12.8%), and >1 complication (0.7% vs 1.9%). The African-American cohort experienced significantly longer hospital stays (C: 1.9 ± 2.3 days vs. AA: 2.7 ± 3.5, P < . 001), greater proportion of extended LOS (C: 17.5% vs AA: 29.1%, P < . 001) and non-routine discharges C: 16.1% non-routine vs. AA: 28.6% non-routine, P < . 001). On multivariate analysis, African-American race was found to be a significant independent risk factor for extended LOS, with an odds-ratio (OR) of 1.98 [95% CI: (1.50, 2.61), P < . 001]. CONCLUSION: Our study suggests that African-American patients have a significantly higher risk of prolonged LOS following elective ACDF for CSM compared to Caucasian patients.