Introduction: Racial inequalities have been described in the outcomes of cardiovascular and orthopedic procedures. Lumbar stenosis is among the most common indications for spine surgery, but there has been minimal investigation of racial disparities in complications and costs of lumbar laminectomies and fusions.
Methods: We analyzed the Medicaid dataset of the Reuter’s MarketScan database. By using this dataset, socioeconomic status is largely controlled for. African American and non-Hispanic white patients who underwent laminectomy or fusion for lumbar stenosis with at least two years post-operative data were included. We examined the effect of race on the rate of re-operations, complications, and the charges associated with surgery.
Results: African American patients in the Medicaid database were at no higher risk for re-operation in the two years following an operation for lumbar stenosis than white patients (7.14% vs 7.89%. p = 0.65). However, we did find that African American patients were more likely to experience post-operative complications of any kind, even after adjusting for length of hospital stay, comorbidities, gender, and age (aOR = 1.6, p = 0.01). White patients had a significantly shorter length of stay (3 vs. 5 days, p < 0.0001) and accrued fewer hospital-related charges ($16,148 vs. $24,267, p < 0.0001). African American patients, despite having more comorbidities in our sample, were prescribed significantly fewer medications in the two years following index procedures (47 vs. 71 prescriptions, p < 0.0001), and had fewer medication charges during the two years after surgery ($5,297 vs. $8450, p = 0.002).
Conclusions: At the national level, there are a number of racial disparities in the rate of complications, length of stay and charges after surgery for lumbar spinal stenosis.
Patient Care: Given that all patients who undergo procedures for lumbar spinal stenosis accept similar risks, it is extremely troubling that different populations enjoy different outcomes based on race. By qualitatively and quantitatively examining the racial disparities in the outcomes of procedures for lumbar spinal stenosis in a uniformly insured population, we provide a framework on which interventions to eliminate the inequalities can be crafted. We hope that our research will stimulate discussion among attendees and lead to a concerted effort to understand and address socioeconomic disparities in neurosurgery.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe how the length of stay, hospital charges, and complications encountered after surgery for lumbar spinal stenosis vary with respect to the patient's race; 2) Identify potential causes of the racial disparity in outcomes of lumbar stenosis operations; 3) Discuss, in small groups, potential interventions that may decrease the impact of race on surgical outcomes.