Racial and Ethnic Disparities in Posterior Cervical Spine Surgery

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: This study aimed to evaluate the extent of racial and ethnic disparities in perioperative outcomes after posterior cervical spine surgeries. SUMMARY OF BACKGROUND DATA: Although racial disparities have been studied in the context of anterior cervical spine surgery, limited literature exists on outcomes after posterior cervical spine procedures. METHODS: Using 2006-2023 National Surgical Quality Improvement Program database, we conducted a study of patients who underwent posterior cervical fusion or cervical laminoplasty. Patients were stratified by race [White, Black or African American (B/AA), Asian, Native Hawaiian or Pacific Islander (NH/PI), American Indian or Alaska Native (AI/AN)] and Hispanic ethnicity. The primary outcome was the incidence of postoperative complications within 30 days. Secondary outcomes included hospital length of stay and discharge disposition. RESULTS: A total of 19,994 patients were included in the study. The majority were White (n=14,276, 71.3%), followed by B/AA (n=3473, 17.4%), Asian (n=822, 4.1%), AI/AN (n=218, 1.1%), NH/PI (n=114, 0.6%), and Hispanic (n=1091, 5.5%). After adjusting for covariates, B/AA race was independently correlated with higher risk of experiencing at least one major complication (OR: 1.264, P=0.005), a medical complication (OR: 1.234, P=0.007), cardiac arrest (OR: 2.631, P=0.001), pulmonary embolism (OR: 1.88, P=0.001), extended hospital stay (OR: 1.921, P<0.001), and non-home discharge (OR: 1.801, P<0.001). NH/PI race was independently correlated with higher odds of prolonged hospitalization (OR: 2.396, P<0.001), as was Hispanic ethnicity (OR: 1.309, P=0.001). CONCLUSIONS: Racial and ethnic minority patients were significantly more likely to experience unfavorable outcomes within 30 days after posterior cervical spine surgery, underscoring the need for interdisciplinary approaches to address inequities in surgical care. LEVEL OF EVIDENCE: Level III.