Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States.
Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, United States.
J Plast Reconstr Aesthet Surg. 2024 Sep;96:114-117. doi: 10.1016/j.bjps.2024.07.036. Epub 2024 Jul 25.
Racial disparities persist in surgical outcomes after spine surgery for primary and metastatic cancers. Muscle flap closure of spinal defects after oncologic resection has been shown to reduce wound complication rate with favorable cost-effectiveness. It is currently unknown whether racial disparities may affect the reception of this treatment.
Spinal surgery procedures for tumor resection and subsequent reconstruction were identified in the 2011-2022 National Surgical Quality Improvement Program databases. Cases were propensity score matched for covariates like age, comorbidities, number of vertebral levels reconstructed, and length of stay to isolate the predictive impact of race on reception of muscle flap closure (p < 0.05).
A total of 9467 patients who underwent oncologic spine surgery and had known race and ethnicity were identified in the final cohort. Two hundred thirty-two (2.5%) cases included muscle flap closure during the index surgery. After matching (n = 4196), minority race/ethnicity was associated with lower rates of muscle flap closure (2.2%) than non-Hispanic White race/ethnicity (3.8%) (p = 0.0037). Upon weighted univariate logistic regression, minority racial and ethnic identification also predicted lower likelihood of muscle flap closure (OR: 0.57, 95% CI: 0.52-0.63, p < 0.001). Among patients who received muscle flap closure, the overall rate of all major or minor thirty-day postoperative complications was not different depending on race and ethnicity (p > 0.05).
There are evident racial disparities in the reception of muscle flap closure after oncologic spine surgery. Further work may investigate the role of intersecting socioeconomic factors like insurance status and hospital characteristics.
Muscle flap closure is a surgical technique within plastic surgery that has been associated with lower rates of complications after spine surgery to remove tumors. Our study shows that minority racial and ethnic groups are less likely on average to receive muscle flap closure.
原发性和转移性癌症脊柱手术后的手术结果仍存在种族差异。肿瘤切除后使用肌瓣闭合脊柱缺损已被证明可降低伤口并发症发生率，并具有良好的成本效益。目前尚不清楚种族差异是否会影响这种治疗方法的接受程度。
在 2011-2022 年国家手术质量改进计划数据库中确定了肿瘤切除术和随后重建的脊柱手术程序。通过倾向评分匹配年龄、合并症、重建的椎体水平数量和住院时间等协变量，以隔离种族对接受肌瓣闭合的预测影响（p<0.05）。
最终队列中共确定了 9467 名接受肿瘤脊柱手术且已知种族和族裔的患者。232 例（2.5%）病例在指数手术中包括肌瓣闭合。匹配后（n=4196），少数民族种族/族裔的肌瓣闭合率（2.2%）低于非西班牙裔白人种族/族裔（3.8%）（p=0.0037）。在加权单变量逻辑回归中，少数民族种族和民族鉴定也预测肌瓣闭合的可能性较低（OR：0.57，95%CI：0.52-0.63，p<0.001）。在接受肌瓣闭合的患者中，种族和族裔与 30 天术后所有主要或次要并发症的总体发生率无关（p>0.05）。
在接受肿瘤脊柱手术后，肌瓣闭合的接受程度存在明显的种族差异。进一步的研究可能会调查保险状况和医院特征等交叉社会经济因素的作用。
肌瓣闭合是一种整形外科手术技术，已被证明可降低脊柱肿瘤切除术后并发症的发生率。我们的研究表明，少数民族群体平均更不可能接受肌瓣闭合。
