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Complications and Mortality in Cervical Spine Surgery: Racial Differences

Skolasky, Richard L., ScD*; Thorpe, Roland J. Jr, PhD; Wegener, Stephen T., PhD; Riley, Lee H. III, MD*

doi: 10.1097/BRS.0000000000000429
Health Services Research

Study Design. Retrospective national database analysis.

Objective. Our goal was to estimate racial and ethnic differences in in-hospital complication and mortality rates associated with cervical spine surgery.

Summary of Background Data. The impact of observed racial and ethnic disparities in orthopedic spine care use on morbidity and mortality is not well understood.

Methods. On the basis of the Nationwide Inpatient Sample, there were 983,420 adult nontrauma hospital discharges from 2000 through 2009. In-hospital complications and mortality were the outcome variables. The primary independent variable was race/ethnicity (defined as non-Hispanic white [white], non-Hispanic black [black], and Hispanic). Covariates were age, sex, household income, insurance status, geographical location, hospital volume, and comorbidities. Multivariable regression models were used to determine the association between race/ethnicity and in-hospital complication and mortality. Significance was set at a P value less than 0.05.

Results. The overall rates of an in-hospital complication or mortality were 4.09% and 0.42%, respectively. There were no differences in the rates of in-hospital complications or mortality between Hispanics and Caucasians. Compared with Caucasians, African Americans had higher odds of experiencing an in-hospital complication (odds ratio, 1.37; 95% confidence interval, 1.27–1.48) and higher odds of dying during hospitalization (odds ratio, 1.59; 95% confidence interval, 1.30–1.96).

Conclusion. Although there were no differences between Caucasians and Hispanics, African Americans had significantly higher rates of in-hospital complications and mortality associated with cervical spine surgery than did Caucasians. These differences persisted after adjusting for known risk factors for complications and mortality.

Level of Evidence: 3

The impact of racial and ethnic disparities on morbidity and mortality after spine surgery is not well understood. Compared with Caucasians, African Americans had 37% higher odds of in-hospital complications and 59% higher odds of dying during hospitalization. These differences persisted after adjusting for known risk factors.

*Orthopaedic Surgery

Health Behavior and Society and Hopkins Center for Health Disparities Solutions, and

Physical Medicine and Rehabilitation, The Johns Hopkins University, Baltimore, MD.

Address correspondence and reprint requests to Richard L. Skolasky, ScD, c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, A665, Baltimore, MD 21224; E-mail:

Acknowledgment date: January 31, 2013. Revision date: April 4, 2014. Acceptance date: April 22, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, employment, and grants/grants pending.

© 2014 by Lippincott Williams & Wilkins