Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
World Neurosurg. 2022 Feb;158:290-304.e1. doi: 10.1016/j.wneu.2021.10.121. Epub 2021 Oct 21.
Our goal was to systematically review the literature on racial/ethnic, insurance, and socioeconomic disparities in adult spine surgery in the United States and analyze potential areas for improvement.
We conducted a database search of literature published between January 1990 and July 2020 using PRISMA guidelines for all studies investigating a disparity in any aspect of adult spine surgery care analyzed based on race/ethnicity, insurance status/payer, or socioeconomic status (SES).
Of 2679 articles identified through database searching, 775 were identified for full-text independent review by 3 authors, from which a final list of 60 studies were analyzed. Forty-three studies analyzed disparities based on patient race/ethnicity, 32 based on insurance status, and 8 based on SES. Five studies assessed disparities in access to care, 15 examined surgical treatment, 35 investigated in-hospital outcomes, and 25 explored after-discharge outcomes. Minority patients were less likely to undergo surgery but more likely to receive surgery from a low-volume provider and experience postoperative complications. White and privately insured patients generally had shorter hospital length of stay, were more likely to undergo favorable/routine discharge, and had lower rates of in-hospital mortality. After discharge, white patients reported better outcomes than did black patients. Thirty-three studies (55%) reported no disparities within at least 1 examined metric.
This comprehensive systematic review underscores ongoing potential for health care disparities among adult patients in spinal surgery. We show a need for continued efforts to promote equity and cultural competency within neurologic surgery.
我们的目标是系统地回顾美国成人脊柱手术中种族/民族、保险和社会经济差异的文献，并分析潜在的改进领域。
我们根据种族/民族、保险状况/支付方或社会经济地位（SES），使用 PRISMA 指南对所有研究进行了数据库搜索，以调查成人脊柱手术护理任何方面的差异，这些研究都纳入了分析。
通过数据库搜索共确定了 2679 篇文章，其中 775 篇文章由 3 位作者进行了全文独立审查，最终分析了 60 项研究。43 项研究分析了基于患者种族/民族的差异，32 项研究分析了基于保险状况的差异，8 项研究分析了基于 SES 的差异。5 项研究评估了获得护理的差异，15 项研究检查了手术治疗，35 项研究调查了住院期间的结果，25 项研究探讨了出院后的结果。少数民族患者接受手术的可能性较小，但更有可能接受低容量提供者的手术，并出现术后并发症。白人患者和私人保险患者的住院时间通常较短，更有可能接受有利/常规出院，住院死亡率较低。出院后，白人患者报告的结果优于黑人患者。33 项研究（55%）在至少 1 项检查指标内报告没有差异。
这项全面的系统综述强调了成人脊柱手术患者的医疗保健差异仍有持续存在的可能性。我们表明，需要继续努力促进神经外科学中的公平和文化能力。
