Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN.
Spine (Phila Pa 1976). 2024 Jun 15;49(12):873-883. doi: 10.1097/BRS.0000000000004935. Epub 2024 Jan 25.
Retrospective analysis of data from the cervical module of a National Spine Registry, the Quality Outcomes Database.
To examine the association of race and ethnicity with patient-reported outcome measures (PROMs) at one year after cervical spine surgery.
Evidence suggests that Black individuals are 39% to 44% more likely to have postoperative complications and a prolonged length of stay after cervical spine surgery compared with Whites. The long-term recovery assessed with PROMs after cervical spine surgery among Black, Hispanic, and other non-Hispanic groups ( i.e . Asian) remains unclear.
PROMs were used to assess disability (neck disability index) and neck/arm pain preoperatively and one-year postoperative. Primary outcomes were disability and pain, and not being satisfied from preoperative to 12 months after surgery. Multivariable logistic and proportional odds regression analyses were used to determine the association of racial/ethnic groups [Hispanic, non-Hispanic White (NHW), non-Hispanic Black (NHB), and non-Hispanic Asian (NHA)] with outcomes after covariate adjustment and to compute the odds of each racial/ethnic group achieving a minimal clinically important difference one-year postoperatively.
On average, the sample of 14,429 participants had significant reductions in pain and disability, and 87% were satisfied at one-year follow-up. Hispanic and NHB patients had higher odds of not being satisfied (40% and 80%) and having worse pain outcomes (30%-70%) compared with NHW. NHB had 50% higher odds of worse disability scores compared with NHW. NHA reported similar disability and neck pain outcomes compared with NHW.
Hispanic and NHB patients had worse patient-reported outcomes one year after cervical spine surgery compared with NHW individuals, even after adjusting for potential confounders, yet there was no difference in disability and neck pain outcomes reported for NHA patients. This study highlights the need to address inherent racial/ethnic disparities in recovery trajectories following cervical spine surgery.
对国家脊柱登记处（Quality Outcomes Database）颈椎模块中数据的回顾性分析。
研究种族和民族与颈椎手术后一年患者报告的结果测量（PROMs）之间的关系。
有证据表明，与白人相比，黑人在颈椎手术后发生术后并发症和住院时间延长的可能性高 39%至 44%。在颈椎手术后，黑人、西班牙裔和其他非西班牙裔群体（即亚洲人）用 PROMs 评估的长期恢复情况尚不清楚。
PROMs 用于评估术前和术后一年的残疾（颈部残疾指数）和颈部/手臂疼痛。主要结果是残疾和疼痛，以及从术前到术后 12 个月不满意。多变量逻辑和比例优势回归分析用于确定种族/民族群体（西班牙裔、非西班牙裔白人（NHW）、非西班牙裔黑人（NHB）和非西班牙裔亚裔（NHA））与调整协变量后的结果之间的关联，并计算每个种族/民族群体在术后一年达到最小临床重要差异的可能性。
平均而言，14429 名参与者的样本疼痛和残疾均有明显减轻，87%的人在一年随访时满意。与 NHW 相比，西班牙裔和 NHB 患者不满意的可能性更高（40%和 80%），疼痛结果更差（30%-70%）。与 NHW 相比，NHB 的残疾评分更差的可能性高 50%。与 NHW 相比，NHA 报告的残疾和颈部疼痛结果相似。
与 NHW 个体相比，西班牙裔和 NHB 患者在颈椎手术后一年的患者报告结果更差，即使在调整了潜在混杂因素后也是如此，但 NHA 患者的残疾和颈部疼痛结果无差异。这项研究强调了需要解决颈椎手术后恢复轨迹中固有的种族/民族差异。
