Racial Disparities Abound When It Comes to Nonelective Surgery

Researchers confirm substantial disparities in the delivery of nonelective surgery.

The study, “Predictors of Nonelective Surgery for Spinal Metastases” is published in the February 2022 issue of the journal Spine.

“Our objectives were to identify patient- and hospital-level factors independently associated with the receipt on nonelective surgery and determine whether nonelective surgery portends differences in perioperative outcomes compared to elective surgery for spinal metastases,” the researchers wrote.

“Spinal metastases may progress to symptomatic epidural spinal cord compression that warrants urgent surgical intervention. Although nonelective surgery for spinal metastases has been associated with poor postoperative outcomes, literature evaluating disparities in the receipt of nonelective versus elective surgery in this population is lacking.”

Data for the analysis was culled from the National Inpatient Sample from 2012 and 2015. After adjusting for disease-related factors and other baseline covariates, the researchers found that Black patients (odds ratio = 1.38, 95% confidence interval:.03-1.84, p = 0.032) and other non-white races (OR = 1.50, 95% CI: 1.13-1.98, p =0.005) were more likely to undergo nonelective surgery than their white counterparts.

In addition, patients of lower income and public insurance status were more likely to receive nonelective surgery than higher income and privately insured patients (p < 0.001).

The researchers also discovered a higher link between higher comorbidity burden and greater odds of non-elective admission (OR = 2.94, 95% CI: 2:07-4.16, p < 0.001). Patients who underwent nonelective surgery were also more likely to experience nonroutine discharge (OR = 2.50, 95% CI: 2:09-2.98, p < 0.001) and extended length of stay (OR= 2.45, 95% CI: 1.91-3.16, p < 0.001).

“The present study demonstrates substantial disparities in the receipt of nonelective surgery across sociodemographic groups and highlights its association with nonroutine discharge and extended length of stay,” the researchers reported.

Study authors included Hammad A. Khan of Case Western Reserve University and Center for Spine Health, Cleveland Clinic, Nicholas M. Rabah of Case Western Reserve University and Center for Spine Health, Cleveland Clinic, Vikram Chakravarthy, M.D., of the Center for Spine Health, Cleveland Clinic, Raghav Tripathi, M.P.H. of Case Western Reserve University, and Ajit Krishnaney, M.D., of the Cleveland Clinic.