Readmission Rates After Spine Surgery Higher for Blacks

When it comes to spine, do Black Lives Matter? Apparently, they do. But not for the better.

Black patients are more likely to be readmitted within 30-days of discharge after elective spine surgery.

That’s according to a study reported in the November issue of Spine: (1 November 2016 – Volume 41 – Issue 21 – p 1677–1682) titled: “Racial Disparities in 30-Day Readmission Rates After Elective Spine Surgery: A Single Institutional Experience, ” it does.

The authors studied whether patient race is an independent predictor of unplanned 30-day hospital readmission after elective spine surgery.

Owoicho Adogwa, M.D. et al. looked at records of 600 patients undergoing elective spine surgery at a major academic medical center. They identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. Patient records were reviewed to determine the cause of readmission and the length of hospital stay. The main outcome measure was risk-adjusted odds of all-cause 30-day readmission. The authors used multivariate logistic regression to determine if Black patients had an increased likelihood of 30-day readmission compared with white patients.

The result? Black patients had higher readmission rates than White patients (10.56% vs. 7.86%, P = 0.04).

In a univariate analysis, race, body mass index, sex, patient age, smoking, diabetes, and fusion levels were associated with increased 30-day readmission rates. However, in a multivariate logistic regression model, race was an independent predictor of 30-day readmission after elective spine surgery. In addition, no significant differences in baseline, 1-year and 2-year patient reported outcomes measures were observed between both groups.

The authors write that efforts at reducing disparities should focus not only on race-based measures but also effective post discharge care.

This isn’t the first study to show ethnic disparities.

Richard Skolasky, M.A., Sc.D., (Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, and others reported in Spine in 2014 that, following cervical spine surgery, the rate of in-hospital complications (including mortality) is significantly higher for Blacks than it is for Whites.

Skolasky et al. state: “Overall, African Americans were significantly more likely to have an in-hospital complication than were Caucasians [5.39% vs. 3.9%; p<0.001); there were no differences between Hispanics and Caucasians.”

The most common systemic complications were cardiac and respiratory. Also, Blacks had 39% higher odds of having an in-hospital complication than whites and this ratio persisted after adjusting for confounding variables.