Disparities in outcomes after spine surgery: a Michigan Spine Surgery Improvement Collaborative study

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  • 1 Department of Neurosurgery, Henry Ford Hospital, Detroit;
  • | 2 Departments of Orthopaedic Surgery and
  • | 3 Neurosurgery, Beaumont Health System, Royal Oak; and
  • | 4 Departments of Orthopaedic Surgery and
  • | 5 Neurosurgery, University of Michigan Hospital, Ann Arbor, Michigan
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OBJECTIVE

Most studies on racial disparities in spine surgery lack data granularity to control for both comorbidities and self-assessment metrics. Analyses from large, multicenter surgical registries can provide an enhanced platform for understanding different factors that influence outcome. In this study, the authors aimed to determine the effects of race on outcomes after lumbar surgery, using patient-reported outcomes (PROs) in 3 areas: the North American Spine Society patient satisfaction index, the minimal clinically important difference (MCID) on the Oswestry Disability Index (ODI) for low-back pain, and return to work.

METHODS

The Michigan Spine Surgery Improvement Collaborative was queried for all elective lumbar operations. Patient race/ethnicity was categorized as Caucasian, African American, and “other.” Measures of association between race and PROs were calculated with generalized estimating equations (GEEs) to report adjusted risk ratios.

RESULTS

The African American cohort consisted of a greater proportion of women with the highest comorbidity burden. Among the 7980 and 4222 patients followed up at 1 and 2 years postoperatively, respectively, African American patients experienced the lowest rates of satisfaction, MCID on ODI, and return to work. Following a GEE, African American race decreased the probability of satisfaction at both 1 and 2 years postoperatively. Race did not affect return to work or achieving MCID on the ODI. The variable of greatest association with all 3 PROs at both follow-up times was postoperative depression.

CONCLUSIONS

While a complex myriad of socioeconomic factors interplay between race and surgical success, the authors identified modifiable risk factors, specifically depression, that may improve PROs among African American patients after elective lumbar spine surgery.

ABBREVIATIONS

GEE = generalized estimating equation; MCID = minimal clinically important difference; MSSIC = Michigan Spine Surgery Improvement Collaborative; ODI = Oswestry Disability Index; PHQ-2 = 2-question version of the Patient Health Questionnaire; PRO = patient-reported outcome; RRadj = adjusted risk ratio.

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Contributor Notes

Correspondence Victor Chang: Henry Ford Hospital, Detroit, MI. vchang1@hfhs.org.

INCLUDE WHEN CITING Published online May 7, 2021; DOI: 10.3171/2020.10.SPINE20914.

Disclosures Dr. Khalil: direct stock ownership in Medtronic, NuVasive, and Johnson & Johnson; consultant for Stryker, Medtronic, Camber Spine, Centinel Spine, and Relievant Medsystems; and clinical or research support for the study described from Stryker, Medtronic, Johnson & Johnson, Centinel Spine, Relievant, Limiflex, and Fziomed. Dr. Perez-Cruet: ownership in Thompson MIS. Dr. Park: consultant for Globus and NuVasive; royalties from Globus; and support of non–study-related clinical or research effort from ISSG and DePuy. Dr. Schwalb: support of non–study-related clinical or research effort from Medtronic, StimWave, and Neuros; consultant for BlueRock and Guidant; and salary support for role as co-director of MSSIC (paid directly to Henry Ford Health System). Dr. Abdulhak: consultant for SeaSpine and Ulrich Medical. Dr. Chang: consultant for Globus Medical, K2M, and Spine-Guard; and research funding from Medtronic.

Although Blue Cross Blue Shield of Michigan (BCBSM) and MSSIC work collaboratively, the opinions, beliefs, and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees. Support for MSSIC is provided by BCBSM and Blue Care Network as part of the BCBSM Value Partnerships program.

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