Elias Elias, Smith Justin, Daoud Ali, Elias Charbel, Nasser Zeina
Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas, USA.
Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
World Neurosurg. 2023 Nov;179:e380-e386. doi: 10.1016/j.wneu.2023.08.097. Epub 2023 Aug 28.
Our objective was to assess the effect of race on outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF).
We identified 57,913 adult patients who underwent elective ACDF spine surgery from 2015 to 2020. Data were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Demographics, comorbidities, perioperative course, and 30-day postoperative outcomes were stratified by race.
A total of 57,913 patients, white (n = 49,016), African American (AA; n = 7200), Native American (NA; n = 565), and Asian (n = 1132) underwent ACDF fusion surgery. AA patients had higher comorbidities, including diabetes (24.7%), dyspnea (5.9%), and hypertension (61.6%) compared with the other groups (P < 0.001). NA and AA were higher tobacco users, (33.1%) and (28.7%), respectively (P < 0.001). Most of the patients reported in this dataset had single-level surgeries. AAs had a longer average hospital stay (2.51±7.31 days) and operative time (144.13±82.26 min) (P < 0.001). Lower risk of superficial surgical site infection (adjusted odds ratio [OR], 0.41; 95% confidence interval [CI], 0.22-0.77; P = 0.005) and greater risk of reintubation (OR, 1.65; 95% CI, 1.25-2.17; P < 0.001), pulmonary embolism (OR, 1.88; 95% CI, 1.27-2.79; P = 0.001), renal insufficiency (OR, 3.15; 95% CI, 1.38-7.20; P = 0.006), and return to the operating room (OR, 1.41; 95% CI, 1.18-1.65; P < 0.001 were reported in AAs compared with whites. NAs showed an increased risk of superficial surgical site infection compared with whites (OR, 2.59; 95% CI, 1.05-6.36; P = 0.037).
Racial disparities were found to independently affect rates of complications after surgery for ACDF.
我们的目的是评估种族对接受颈椎前路椎间盘切除融合术（ACDF）患者预后的影响。
我们确定了2015年至2020年期间接受择期ACDF脊柱手术的57913例成年患者。数据从美国外科医师学会国家外科质量改进计划（ACS NSQIP）数据库中提取。人口统计学、合并症、围手术期过程和术后30天的结果按种族进行分层。
共有57913例患者接受了ACDF融合手术，其中白人（n = 49016）、非裔美国人（AA；n = 7200）、美洲原住民（NA；n = 565）和亚洲人（n = 1132）。与其他组相比，AA患者有更高的合并症，包括糖尿病（24.7%）、呼吸困难（5.9%）和高血压（61.6%）（P < 0.001）。NA和AA分别有更高的烟草使用率，分别为（33.1%）和（28.7%）（P < 0.001）。该数据集中报告的大多数患者进行了单节段手术。AA患者的平均住院时间（2.51±7.31天）和手术时间（144.13±82.26分钟）更长（P < 0.001）。与白人相比，AA患者浅表手术部位感染的风险较低（调整后的优势比[OR]，0.41；95%置信区间[CI]，0.22 - 0.77；P = 0.005），而再插管（OR，1.65；95% CI，1.25 - 2.17；P < 0.001）、肺栓塞（OR，1.88；95% CI，1.27 - 2.79；P = 0.001）、肾功能不全（OR，3.15；95% CI，1.38 - 7.20；P = 0.006）和返回手术室（OR，1.41；95% CI，1.18 - 1.65；P < 0.001）的风险更高。与白人相比，NA患者浅表手术部位感染的风险增加（OR，2.59；95% CI，1.05 - 6.36；P = 0.037）。
发现种族差异独立影响ACDF手术后的并发症发生率。
