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  • Racial Disparity in Total Hospital Length of Stay for Adults Undergoing Elective ACDF

    Final Number:

    Parth Kothari BS; Samuel K Cho MD; Javier Z Guzman BS; Nathan John Lee BS; John I Shin BS; Jeremy Steinberger MD; Branko Skovrlj MD; Dante Leven DO

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Racial disparities are an important component of healthcare cost inequalities. It is important to become more familiar with racial differences in patients undergoing spine surgery.

    Methods: Patients were identified by CPT (Current Procedural Terminology) code in the American College of Surgeon’s National Surgical Quality Improvement Program (ACS-NSQIP) database. A univariate analysis was performed to compare demographics, comorbidities, operative and postoperative complications across Hispanics, Blacks and Whites. Multivariate step-wise logistic regression was performed on each complication that demonstrated significant association to race in the univariate comparison. Race and any perioperative variables with P<0.2 were included in the multivariate analyses. White race was set as the reference for the race category. Level of significance was set at p=0.05.

    Results: Hispanics were more likely to be = 65 years of age than Whites or Blacks (23.08% vs. 16.41% vs. 12.01%)(p=0.002). Smoking status was least amongst Hispanic patients (23.56% vs. 33.7 Blacks vs. 33.55% Whites)(p=0.002). With regards to comorbidities, Hispanics were observed to have a greater rate of neuromuscular injury (p<0.0001) and previous stroke (p=0.0001) than White or Black patients undergoing ACDF. Length of stay (LOS) > 5 days was more often to be experienced by Black or Hispanic patients than White patients, respectively (11.235 vs. 7.69% vs. 4.96%)(p<0.0001). Postoperative blood transfusion was observed at a greater rate in Hispanics (1.44%) than in Blacks (1.04%) or Whites (0.35%) (p=0.027). Multivariate for LOS > 5 days shows that Black race [Adjusted Odds Ratio (OR)=2.36, p=0.002] but not Hispanic race is an independent predictor of prolonged LOS.

    Conclusions: Black race when using White race as reference is an independent predictor of prolonged LOS in patients undergoing ACDF. Further research may be warranted in this area.

    Patient Care: This work will help physicians better understand the impact of race on hospital length of stay. Better understanding of risk factors for ACDF surgery is necessary for improving patient care and stratifying risk appropriately.

    Learning Objectives: By the conclusion of this session, participants should be able to understand the impact of race on length of stay in patients undergoing ACDF.


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