Khan Mohammad F, Patel Saarang, Putzler Dillon H, Albert Avi N, Khan Hibbah I, Gensler Ryan T, Abella Maveric, Hayashi Jeffrey, Paulo Frishan O, Gendreau Julian L, Bow-Keola Janette, Finlay Andrea, Amanatullah Derek F, Noh Thomas
Neurosurgery, Indiana University School of Medicine, Indianapolis, USA.
Biological Sciences, Seton Hall University, South Orange, USA.
Cureus. 2025 Mar 29;17(3):e81409. doi: 10.7759/cureus.81409. eCollection 2025 Mar.
Racial disparities in surgical outcomes are well documented, yet data on American Indian/Alaskan Native (AI/AN) and Native Hawaiian/Pacific Islander (NH/PI) populations remain limited. This study examines disparities in 30-day outcomes following lumbar decompression and fusion in these underrepresented groups.
A retrospective analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program database (2017-2020). Patients undergoing lumbar decompression and fusion were identified via current procedural terminology codes. Multivariable logistic regression models adjusted for demographic and clinical factors assessed associations between race/ethnicity and postoperative outcomes, including readmission, complications, reoperation, and non-home discharge. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported.
Among 113,340 patients, 0.38% (n=429) were AI/AN patients and 0.20% (n=229) were NH/PI patients. Compared to non-Hispanic White patients, AI/AN patients had higher odds of readmission (AOR: 1.023, 95% CI: 1.003-1.043, p=0.026) and complications (AOR: 1.030, 95% CI: 1.004-1.056, p=0.023). NH/PI patients had increased odds of readmission (AOR: 1.033, 95% CI: 1.006-1.062, p=0.018), major complications (AOR: 1.029, 95% CI: 1.007-1.051, p=0.009), and reoperation (AOR: 1.035, 95% CI: 1.014-1.057, p=0.001).
AI/AN and NH/PI patients face higher risks of adverse postoperative outcomes following lumbar spine surgery. Targeted interventions and increased inclusion in surgical disparities research are needed to improve equity in spine care.
手术结果中的种族差异已有充分记录，但关于美国印第安人/阿拉斯加原住民（AI/AN）和夏威夷原住民/太平洋岛民（NH/PI）人群的数据仍然有限。本研究调查了这些代表性不足群体在腰椎减压融合术后30天结果方面的差异。
使用美国外科医师学会国家外科质量改进计划数据库（2017 - 2020年）进行回顾性分析。通过当前手术操作术语代码识别接受腰椎减压融合术的患者。针对人口统计学和临床因素进行调整的多变量逻辑回归模型评估了种族/民族与术后结果之间的关联，包括再入院、并发症、再次手术和非回家出院情况。报告了调整后的比值比（AOR）及95%置信区间（CI）。
在113,340例患者中，0.38%（n = 429）为AI/AN患者，0.20%（n = 229）为NH/PI患者。与非西班牙裔白人患者相比，AI/AN患者再入院（AOR：1.023，95% CI：1.003 - 1.043，p = 0.026）和出现并发症（AOR：1.030，95% CI：1.004 - 1.056，p = 0.023）的几率更高。NH/PI患者再入院（AOR：1.033，95% CI：1.006 - 1.062，p = 0.018）、发生重大并发症（AOR：1.029，95% CI：1.007 - 1.051，p = 0.009）和再次手术（AOR：1.035，95% CI：1.014 - 1.057，p = 0.001）的几率增加。
AI/AN和NH/PI患者在腰椎手术后面临更高的术后不良结果风险。需要有针对性的干预措施，并增加在手术差异研究中的纳入比例，以改善脊柱护理的公平性。
