Complications and mortality in cervical spine surgery: racial differences

Abstract

Study design: Retrospective national database analysis.

Objective: Our goal was to estimate racial and ethnic differences in in-hospital complication and mortality rates associated with cervical spine surgery.

Summary of background data: The impact of observed racial and ethnic disparities in orthopedic spine care use on morbidity and mortality is not well understood.

Methods: On the basis of the Nationwide Inpatient Sample, there were 983,420 adult nontrauma hospital discharges from 2000 through 2009. In-hospital complications and mortality were the outcome variables. The primary independent variable was race/ethnicity (defined as non-Hispanic white [white], non-Hispanic black [black], and Hispanic). Covariates were age, sex, household income, insurance status, geographical location, hospital volume, and comorbidities. Multivariable regression models were used to determine the association between race/ethnicity and in-hospital complication and mortality. Significance was set at a P value less than 0.05.

Results: The overall rates of an in-hospital complication or mortality were 4.09% and 0.42%, respectively. There were no differences in the rates of in-hospital complications or mortality between Hispanics and Caucasians. Compared with Caucasians, African Americans had higher odds of experiencing an in-hospital complication (odds ratio, 1.37; 95% confidence interval, 1.27-1.48) and higher odds of dying during hospitalization (odds ratio, 1.59; 95% confidence interval, 1.30-1.96).

Conclusion: Although there were no differences between Caucasians and Hispanics, African Americans had significantly higher rates of in-hospital complications and mortality associated with cervical spine surgery than did Caucasians. These differences persisted after adjusting for known risk factors for complications and mortality.

Level of evidence: 3.