Perelman School of Medicine, University of Pennsylvania.
Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
Clin Spine Surg. 2022 May 1;35(4):176-180. doi: 10.1097/BSD.0000000000001312. Epub 2022 Mar 29.
This was a retrospective chart review.
The objective of this study was to examine disparities within patients undergoing anterior cervical discectomy and fusion (ACDF) at a multi-site tertiary referral center with specific focus on factors related to length of stay (LOS).
There are previously described racial disparities in spinal surgery outcomes and quality metrics.
A total of 278 consecutive patients undergoing ACDF by 8 different surgeons over a 5-year period were identified retrospectively. Demographic data, including age at time of surgery, sex, smoking status, and self-identified race [White or African American (AA)], as well as surgical data and postoperative course were recorded. Preoperative health status was recorded, and comorbidities were scored by the Charlson Comorbidity Index. Univariable and multivariable linear regression models were employed to quantify the degree to which a patient's LOS was related to their self-identified race, demographics, and perioperative clinical data.
Of the 278 patients who received an ACDF, 71.6% (199) self-identified as White and 28.4% (79) identified as AA. AA patients were more likely to have an ACDF due to myelopathy, while White patients were more likely to have an ACDF due to radiculopathy (P=0.001). AA patients had longer LOS by an average of half a day (P=0.001) and experienced a larger percentage of extended stays (P=0.002). AA patients experienced longer overall operation times on average (P=0.001) across all different levels of fusion. AA race was not an independent driver of LOS (β=0.186; P=0.246).
As hypothesized, and consistent with previous literature on racial surgical disparities, AA race was associated with increased LOS, increased operative times, and increased indication of myelopathy in this study. Additional research is necessary to evaluate the underlying social determinants of health and other factors that may contribute to this study's results.
Level III.
这是一项回顾性图表回顾。
本研究的目的是检查在一家多站点三级转诊中心接受前路颈椎间盘切除融合术（ACDF）的患者之间的差异，重点关注与住院时间（LOS）相关的因素。
先前有描述过脊柱手术结果和质量指标方面的种族差异。
回顾性地确定了在 5 年内由 8 位不同外科医生进行的 278 例连续 ACDF 患者。记录了人口统计学数据，包括手术时的年龄、性别、吸烟状况和自我认定的种族[白人或非裔美国人（AA）]，以及手术数据和术后过程。记录了术前健康状况，并通过 Charlson 合并症指数对合并症进行评分。使用单变量和多变量线性回归模型来量化患者的 LOS 与其自我认定的种族、人口统计学和围手术期临床数据之间的关系程度。
在接受 ACDF 的 278 例患者中，71.6%（199 例）自我认定为白人，28.4%（79 例）认定为 AA。AA 患者更有可能因脊髓病而接受 ACDF，而白人患者更有可能因神经根病而接受 ACDF（P=0.001）。AA 患者的 LOS 平均延长了半天（P=0.001），并且经历了更大比例的延长停留时间（P=0.002）。AA 患者在所有融合水平的平均手术时间都较长（P=0.001）。AA 种族并不是 LOS 的独立驱动因素（β=0.186；P=0.246）。
正如假设的那样，并且与之前关于种族手术差异的文献一致，在这项研究中，AA 种族与延长 LOS、延长手术时间以及增加脊髓病的指示相关。需要进一步研究来评估健康的潜在社会决定因素和可能导致本研究结果的其他因素。
III 级。
