Disparities in outcomes after spine surgery: a Michigan Spine Surgery Improvement Collaborative study.

Authors

Mohamed Macki
Travis Hamilton
Seokchun Lim
Edvin Telemi
Michael Bazydlo
David R Nerenz
Hesham Mostafa Zakaria
Lonni Schultz
Jad G. Khalil, Beaumont Health
Miguelangelo J. Perez-Cruet, Beaumont Health
Ilyas S Aleem
Paul Park, Beaumont Health Resident
Jason M Schwalb
Muwaffak M Abdulhak
Victor Chang

Document Type

Article

Publication Date

5-7-2021

Publication Title

Journal of neurosurgery. Spine

Abstract

OBJECTIVE: Most studies on racial disparities in spine surgery lack data granularity to control for both comorbidities and self-assessment metrics. Analyses from large, multicenter surgical registries can provide an enhanced platform for understanding different factors that influence outcome. In this study, the authors aimed to determine the effects of race on outcomes after lumbar surgery, using patient-reported outcomes (PROs) in 3 areas: the North American Spine Society patient satisfaction index, the minimal clinically important difference (MCID) on the Oswestry Disability Index (ODI) for low-back pain, and return to work.

METHODS: The Michigan Spine Surgery Improvement Collaborative was queried for all elective lumbar operations. Patient race/ethnicity was categorized as Caucasian, African American, and "other." Measures of association between race and PROs were calculated with generalized estimating equations (GEEs) to report adjusted risk ratios.

RESULTS: The African American cohort consisted of a greater proportion of women with the highest comorbidity burden. Among the 7980 and 4222 patients followed up at 1 and 2 years postoperatively, respectively, African American patients experienced the lowest rates of satisfaction, MCID on ODI, and return to work. Following a GEE, African American race decreased the probability of satisfaction at both 1 and 2 years postoperatively. Race did not affect return to work or achieving MCID on the ODI. The variable of greatest association with all 3 PROs at both follow-up times was postoperative depression.

CONCLUSIONS: While a complex myriad of socioeconomic factors interplay between race and surgical success, the authors identified modifiable risk factors, specifically depression, that may improve PROs among African American patients after elective lumbar spine surgery.

First Page

1

Last Page

9

Recommended Citation

Macki M, Hamilton T, Lim S, Telemi E, Bazydlo M, Nerenz DR, Zakaria HM, Schultz L, Khalil JG, Perez-Cruet MJ, Aleem IS, Park P, Schwalb JM, Abdulhak MM, Chang V. Disparities in outcomes after spine surgery: a Michigan Spine Surgery Improvement Collaborative study. J Neurosurg Spine. 2021 May 7:1-9. doi: 10.3171/2020.10.SPINE20914. Epub ahead of print. PMID: 33962387.

Comments

Epub ahead of print

DOI

10.3171/2020.10.SPINE20914

ISSN

1547-5646

PubMed ID

33962387