Racial disparities in outcomes of spinal surgery for lumbar stenosis

Shivanand P. Lad, Jacob H. Bagley, Krista T. Kenney, Beatrice Ugiliweneza, Maiying Kong, Carlos A. Bagley, Oren N. Gottfried, Robert E. Isaacs, Chirag G. Patil, Maxwell Boakye

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objective. To evaluate racial disparities in outcomes of lumbar stenosis surgery. Summary of Background Data. Racial inequalities have been described in the outcomes of cardiovascular and orthopedic procedures. There have been minimal investigation of racial disparities in complications and costs of lumbar laminectomies and fusions. Methods. We analyzed the Medicaid data set of Thomson Reuter's MarketScan database. African-American and non-Hispanic white patients who underwent laminectomy or fusion for lumbar stenosis with at least 2 years postoperative data were included. We examined the effect of race on the rate of reoperations, complications, and the cost associated with surgery. Results. African-American patients in the Medicaid database were at no higher risk for reoperation in the 2 years after an operation for lumbar stenosis than white patients (7.14% vs. 7.89%, P = 0.7895). However, we did find that African-American patients were more likely to experience postoperative complications of any kind, even after adjusting for length of hospital stay, comorbidities, sex, and age (adjusted odds ratio = 1.819, P = 0.0123 for immediate complication; adjusted odds ratio = 1.746, P = 0.0141 for 30-d complication; and adjusted odds ratio = 1.611, P = 0.0410 for 90-d complication). White patients had a significantly shorter length of stay (3 vs. 5 d, P < 0.007) and accrued fewer hospital-related costs ($16,148 vs. $24,267, P < 0.0007). African-American patients, despite having more comorbidities in our sample, were prescribed significantly fewer medications in the 2 years after index procedures (91 vs. 138 prescriptions, P < 0.0007) and had fewer medication costs during the 2 years after surgery ($5297 vs. $8450, P < 0.0007). Conclusion. At the national level, there are several racial disparities in the rate of complications, length of stay, and costs after surgery for lumbar spinal stenosis.

Original languageEnglish (US)
Pages (from-to)927-935
Number of pages9
JournalSpine
Volume38
Issue number11
DOIs
StatePublished - May 15 2013

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Pathologic Constriction
African Americans
Length of Stay
Costs and Cost Analysis
Laminectomy
Odds Ratio
Medicaid
Reoperation
Comorbidity
Databases
Orthopedic Procedures
Spinal Stenosis
Hospital Costs
Prescriptions

Keywords

  • Complication
  • Disparity
  • Fusion
  • Lumbar stenosis
  • Medicaid
  • Race

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Lad, S. P., Bagley, J. H., Kenney, K. T., Ugiliweneza, B., Kong, M., Bagley, C. A., ... Boakye, M. (2013). Racial disparities in outcomes of spinal surgery for lumbar stenosis. Spine, 38(11), 927-935. https://doi.org/10.1097/BRS.0b013e31828165f9

Racial disparities in outcomes of spinal surgery for lumbar stenosis. / Lad, Shivanand P.; Bagley, Jacob H.; Kenney, Krista T.; Ugiliweneza, Beatrice; Kong, Maiying; Bagley, Carlos A.; Gottfried, Oren N.; Isaacs, Robert E.; Patil, Chirag G.; Boakye, Maxwell.

In: Spine, Vol. 38, No. 11, 15.05.2013, p. 927-935.

Research output: Contribution to journalArticle

Lad, SP, Bagley, JH, Kenney, KT, Ugiliweneza, B, Kong, M, Bagley, CA, Gottfried, ON, Isaacs, RE, Patil, CG & Boakye, M 2013, 'Racial disparities in outcomes of spinal surgery for lumbar stenosis', Spine, vol. 38, no. 11, pp. 927-935. https://doi.org/10.1097/BRS.0b013e31828165f9
Lad SP, Bagley JH, Kenney KT, Ugiliweneza B, Kong M, Bagley CA et al. Racial disparities in outcomes of spinal surgery for lumbar stenosis. Spine. 2013 May 15;38(11):927-935. https://doi.org/10.1097/BRS.0b013e31828165f9
Lad, Shivanand P. ; Bagley, Jacob H. ; Kenney, Krista T. ; Ugiliweneza, Beatrice ; Kong, Maiying ; Bagley, Carlos A. ; Gottfried, Oren N. ; Isaacs, Robert E. ; Patil, Chirag G. ; Boakye, Maxwell. / Racial disparities in outcomes of spinal surgery for lumbar stenosis. In: Spine. 2013 ; Vol. 38, No. 11. pp. 927-935.
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abstract = "Objective. To evaluate racial disparities in outcomes of lumbar stenosis surgery. Summary of Background Data. Racial inequalities have been described in the outcomes of cardiovascular and orthopedic procedures. There have been minimal investigation of racial disparities in complications and costs of lumbar laminectomies and fusions. Methods. We analyzed the Medicaid data set of Thomson Reuter's MarketScan database. African-American and non-Hispanic white patients who underwent laminectomy or fusion for lumbar stenosis with at least 2 years postoperative data were included. We examined the effect of race on the rate of reoperations, complications, and the cost associated with surgery. Results. African-American patients in the Medicaid database were at no higher risk for reoperation in the 2 years after an operation for lumbar stenosis than white patients (7.14{\%} vs. 7.89{\%}, P = 0.7895). However, we did find that African-American patients were more likely to experience postoperative complications of any kind, even after adjusting for length of hospital stay, comorbidities, sex, and age (adjusted odds ratio = 1.819, P = 0.0123 for immediate complication; adjusted odds ratio = 1.746, P = 0.0141 for 30-d complication; and adjusted odds ratio = 1.611, P = 0.0410 for 90-d complication). White patients had a significantly shorter length of stay (3 vs. 5 d, P < 0.007) and accrued fewer hospital-related costs ($16,148 vs. $24,267, P < 0.0007). African-American patients, despite having more comorbidities in our sample, were prescribed significantly fewer medications in the 2 years after index procedures (91 vs. 138 prescriptions, P < 0.0007) and had fewer medication costs during the 2 years after surgery ($5297 vs. $8450, P < 0.0007). Conclusion. At the national level, there are several racial disparities in the rate of complications, length of stay, and costs after surgery for lumbar spinal stenosis.",
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AU - Kong, Maiying

AU - Bagley, Carlos A.

AU - Gottfried, Oren N.

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N2 - Objective. To evaluate racial disparities in outcomes of lumbar stenosis surgery. Summary of Background Data. Racial inequalities have been described in the outcomes of cardiovascular and orthopedic procedures. There have been minimal investigation of racial disparities in complications and costs of lumbar laminectomies and fusions. Methods. We analyzed the Medicaid data set of Thomson Reuter's MarketScan database. African-American and non-Hispanic white patients who underwent laminectomy or fusion for lumbar stenosis with at least 2 years postoperative data were included. We examined the effect of race on the rate of reoperations, complications, and the cost associated with surgery. Results. African-American patients in the Medicaid database were at no higher risk for reoperation in the 2 years after an operation for lumbar stenosis than white patients (7.14% vs. 7.89%, P = 0.7895). However, we did find that African-American patients were more likely to experience postoperative complications of any kind, even after adjusting for length of hospital stay, comorbidities, sex, and age (adjusted odds ratio = 1.819, P = 0.0123 for immediate complication; adjusted odds ratio = 1.746, P = 0.0141 for 30-d complication; and adjusted odds ratio = 1.611, P = 0.0410 for 90-d complication). White patients had a significantly shorter length of stay (3 vs. 5 d, P < 0.007) and accrued fewer hospital-related costs ($16,148 vs. $24,267, P < 0.0007). African-American patients, despite having more comorbidities in our sample, were prescribed significantly fewer medications in the 2 years after index procedures (91 vs. 138 prescriptions, P < 0.0007) and had fewer medication costs during the 2 years after surgery ($5297 vs. $8450, P < 0.0007). Conclusion. At the national level, there are several racial disparities in the rate of complications, length of stay, and costs after surgery for lumbar spinal stenosis.

AB - Objective. To evaluate racial disparities in outcomes of lumbar stenosis surgery. Summary of Background Data. Racial inequalities have been described in the outcomes of cardiovascular and orthopedic procedures. There have been minimal investigation of racial disparities in complications and costs of lumbar laminectomies and fusions. Methods. We analyzed the Medicaid data set of Thomson Reuter's MarketScan database. African-American and non-Hispanic white patients who underwent laminectomy or fusion for lumbar stenosis with at least 2 years postoperative data were included. We examined the effect of race on the rate of reoperations, complications, and the cost associated with surgery. Results. African-American patients in the Medicaid database were at no higher risk for reoperation in the 2 years after an operation for lumbar stenosis than white patients (7.14% vs. 7.89%, P = 0.7895). However, we did find that African-American patients were more likely to experience postoperative complications of any kind, even after adjusting for length of hospital stay, comorbidities, sex, and age (adjusted odds ratio = 1.819, P = 0.0123 for immediate complication; adjusted odds ratio = 1.746, P = 0.0141 for 30-d complication; and adjusted odds ratio = 1.611, P = 0.0410 for 90-d complication). White patients had a significantly shorter length of stay (3 vs. 5 d, P < 0.007) and accrued fewer hospital-related costs ($16,148 vs. $24,267, P < 0.0007). African-American patients, despite having more comorbidities in our sample, were prescribed significantly fewer medications in the 2 years after index procedures (91 vs. 138 prescriptions, P < 0.0007) and had fewer medication costs during the 2 years after surgery ($5297 vs. $8450, P < 0.0007). Conclusion. At the national level, there are several racial disparities in the rate of complications, length of stay, and costs after surgery for lumbar spinal stenosis.

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