Elsamadicy Aladine A, Belkasim Selma, Serrato Paul, Sadeghzadeh Sina, Ghanekar Shaila D, Khalid Syed I, Lo Sheng-Fu Larry, Sciubba Daniel M
Department of Neurosurgery, Yale University School of Medicine, New Haven, CT.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA.
Spine (Phila Pa 1976). 2025 Jun 15;50(12):823-831. doi: 10.1097/BRS.0000000000005260. Epub 2025 Jan 21.
Retrospective cohort study.
This study aimed to investigate the association of race with morbidity and mortality in acute cervical spinal cord injury (cSCI) patients.
Racial disparities in spine surgery are associated with adverse outcomes, however, the impact of race on cSCI is understudied.
We retrospectively reviewed the American College of Surgeons Trauma Quality Programs database to compare outcomes for acute cSCI patients between racial/ethnic identities: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic/Latino (HIS), and other (OTH). Demographics, comorbidities, injury type, treatment modality, and adverse events (AEs) were assessed. Multivariable logistic regression was used to identify independent predictors of AEs, non-routine discharge (NRD), and in-hospital mortality.
There were 71,048 patients stratified by race/ethnicity: 44,639 (62.8%) NHW, 13,555 (19.1%) NHB, 5820 (8.2%) HIS, and 7034 (9.9%) OTH. NHB and HIS-identifying patients had the greatest rates of any AE (NHW: 20.7% vs. NHB: 25.0% vs. HIS: 24.6% vs. OTH: 22.0%, P < 0.001) and the longest mean length of stay (NHW: 11.3 ± 13.5 d vs. NHB: 15.5 ± 20.2 d vs. HIS: 15.0 ± 20.5 d vs. OTH: 12.6 ± 17.5 d, P < 0.001). NRDs were lowest for HIS-identifying patients (NHW: 74.8% vs. NHB: 75.5% vs . HIS: 69.5% vs . OTH: 75.4%, P < 0.001), whereas, in-hospital mortality was lowest for NHB-identifying patients (NHW: 12.8% vs . NHB: 10.1% vs . HIS: 12.4% vs . OTH: 13.4%, P < 0.001). On multivariable analyses, NHB odds ratio (OR: 1.16, P < 0.001), HIS (OR: 1.22, P < 0.001), and OTH (OR: 1.14, P = 0.004) cohorts had significantly increased odds of AEs. The NHB cohort had significantly increased odds (OR: 1.25, P < 0.001), whereas, the HIS cohort had significantly decreased odds (OR: 0.78, P = 0.001) of NRD. Only the NHB cohort had significantly decreased odds of in-hospital mortality (OR: 0.69, P <0 .001).
Our study suggests there may be racial disparities in outcomes and discharge disposition for acute cSCI patients.
回顾性队列研究。
本研究旨在调查急性颈脊髓损伤（cSCI）患者的种族与发病率和死亡率之间的关联。
脊柱手术中的种族差异与不良预后相关，然而，种族对cSCI的影响研究较少。
我们回顾性分析了美国外科医师学会创伤质量项目数据库，以比较不同种族/族裔身份的急性cSCI患者的预后：非西班牙裔白人（NHW）、非西班牙裔黑人（NHB）、西班牙裔/拉丁裔（HIS）和其他（OTH）。评估了人口统计学、合并症、损伤类型、治疗方式和不良事件（AE）。采用多变量逻辑回归来确定AE、非常规出院（NRD）和院内死亡率的独立预测因素。
按种族/族裔分层的患者有71,048例：44,639例（62.8%）NHW、13,555例（19.1%）NHB、5,820例（8.2%）HIS和7,034例（9.9%）OTH。NHB和HIS身份的患者发生任何AE的比例最高（NHW：20.7%，NHB：25.0%，HIS：24.6%，OTH：22.0%，P<0.001），平均住院时间最长（NHW：11.3±13.5天，NHB：15.5±20.2天，HIS：15.0±20.5天，OTH：12.6±17.5天，P<0.001）。HIS身份的患者NRD最低（NHW：74.8%，NHB：75.5%，HIS：69.5%，OTH：75.4%，P<0.001），而NHB身份的患者院内死亡率最低（NHW：12.8%，NHB：10.1%，HIS：12.4%，OTH：13.4%，P<0.001）。多变量分析显示，NHB（比值比[OR]：1.16，P<0.001）、HIS（OR：1.22，P<0.001）和OTH（OR：1.14，P=0.004）队列发生AE的几率显著增加。NHB队列发生NRD的几率显著增加（OR：1.25，P<0.001），而HIS队列发生NRD的几率显著降低（OR：0.78，P=0.001）。只有NHB队列院内死亡率的几率显著降低（OR：0.69，P<0.001）。
我们的研究表明，急性cSCI患者的预后和出院处置可能存在种族差异。
