Elsamadicy Aladine A, Ghanekar Shaila D, Serrato Paul, Mitre Lucas P, Kolb Luis, Lo Sheng-Fu Larry, Sciubba Daniel M
Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA.
Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA.
J Clin Neurosci. 2025 Jul;137:111351. doi: 10.1016/j.jocn.2025.111351. Epub 2025 May 29.
Investigation into the effect of demographic identifiers, such as race and socioeconomic status, on health outcomes has risen to the forefront of research across medical disciplines attempting to understand the complex interplay of factors that lead to health disparities. This study aims to identify racial disparities in outcomes following spine surgery for spinal epidural abscess (SEA).
We conducted a retrospective cohort study using the 2011-2022 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database to identify adult patients who underwent spinal surgery for spinal epidural abscess. The study population was stratified by race and ethnicity into four groups: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic (HIS), and Other (OTH). Multivariable logistic regression analyses were performed to identify factors associated with extended length of stay (LOS), adverse events (AEs), non-routine discharge (NRD), 30-day unplanned reoperation, and mortality.
Of the 1,654 adult patients, 1198 (72.4 %) identified as NHW, 184 (11.1 %) identified as NHB, 188 (11.4 %) identified as HIS, and 84 (5.1 %) identified as OTH. The NHB cohort had the highest proportion of individuals with mFI-5 scores > 2 (NHW: 26.9 % vs. NHB: 39.1 % vs. Hispanic: 27.7 % vs. Other: 34.5 %, p = 0.002). No significant difference in rates of 30-day AEs, LOS, operation time, NRD, 30-day reoperation, or mortality were noted between the groups. On both univariate (OR: 1.80, CI: 1.10-2.93, p = 0.019) and multivariate (aOR: 2.48, CI: 1.41-4.38, p = 0.002) analysis, the OTH cohort was associated with a significantly higher risk of extended hospitalization. There were no other significant associations between cohort and risk for AEs, NRD, 30-day reoperation, or mortality.
Our study suggests that there are reduced racial disparities in post-surgical outcomes for SEA patients. Additionally, the comorbidity burden seems to be associated with worsening outcomes. Further studies are necessary to corroborate our findings.
对种族和社会经济地位等人口统计学标识符对健康结果的影响的调查已成为各医学学科研究的前沿，旨在了解导致健康差距的因素之间复杂的相互作用。本研究旨在确定脊柱硬膜外脓肿（SEA）脊柱手术后结果中的种族差异。
我们使用2011 - 2022年美国外科医师学会（ACS）国家外科质量改进计划（NSQIP）数据库进行了一项回顾性队列研究，以确定接受脊柱硬膜外脓肿脊柱手术的成年患者。研究人群按种族和族裔分为四组：非西班牙裔白人（NHW）、非西班牙裔黑人（NHB）、西班牙裔（HIS）和其他（OTH）。进行多变量逻辑回归分析以确定与延长住院时间（LOS）、不良事件（AE）、非常规出院（NRD）、30天计划外再次手术和死亡率相关的因素。
在1654名成年患者中，1198名（72.4%）被认定为NHW，184名（11.1%）被认定为NHB，188名（11.4%）被认定为HIS，84名（5.1%）被认定为OTH。NHB队列中mFI - 5评分>2的个体比例最高（NHW：26.9% vs. NHB：39.1% vs. 西班牙裔：27.7% vs. 其他：34.5%，p = 0.002）。各组之间在30天AE发生率、LOS、手术时间、NRD、30天再次手术率或死亡率方面未发现显著差异。在单变量（OR：1.80，CI：1.10 - 2.93，p = 0.019）和多变量（aOR：2.48，CI：1.41 - 4.38，p = 0.002）分析中，OTH队列与延长住院风险显著更高相关。队列与AE、NRD、30天再次手术或死亡率风险之间没有其他显著关联。
我们的研究表明，SEA患者术后结果中的种族差异有所减少。此外，合并症负担似乎与预后恶化有关。需要进一步研究来证实我们的发现。
