Impact of Racial/Ethnic Disparities on Patient-Reported Outcomes Following Cervical Spine Surgery: QOD Analysis.

Study Design: Retrospective analysis of data from the cervical module of a National Spine Registry, the Quality Outcomes Database.
Objective: To examine the association of race and ethnicity with patient-reported outcome measures (PROMs) at one year after cervical spine surgery.
Summary of Background Data: Evidence suggests that Black individuals are 39% to 44% more likely to have postoperative complications and a prolonged length of stay after cervical spine surgery compared with Whites. The long-term recovery assessed with PROMs after cervical spine surgery among Black, Hispanic, and other non-Hispanic groups ( i.e . Asian) remains unclear.
Materials and Methods: PROMs were used to assess disability (neck disability index) and neck/arm pain preoperatively and one-year postoperative. Primary outcomes were disability and pain, and not being satisfied from preoperative to 12 months after surgery. Multivariable logistic and proportional odds regression analyses were used to determine the association of racial/ethnic groups [Hispanic, non-Hispanic White (NHW), non-Hispanic Black (NHB), and non-Hispanic Asian (NHA)] with outcomes after covariate adjustment and to compute the odds of each racial/ethnic group achieving a minimal clinically important difference one-year postoperatively.
Results: On average, the sample of 14,429 participants had significant reductions in pain and disability, and 87% were satisfied at one-year follow-up. Hispanic and NHB patients had higher odds of not being satisfied (40% and 80%) and having worse pain outcomes (30%-70%) compared with NHW. NHB had 50% higher odds of worse disability scores compared with NHW. NHA reported similar disability and neck pain outcomes compared with NHW.
Conclusions: Hispanic and NHB patients had worse patient-reported outcomes one year after cervical spine surgery compared with NHW individuals, even after adjusting for potential confounders, yet there was no difference in disability and neck pain outcomes reported for NHA patients. This study highlights the need to address inherent racial/ethnic disparities in recovery trajectories following cervical spine surgery.
Competing Interests: J.S.P. reports personal fees from 3Spine and Steamboat Orthopaedic and Spine Institute. R.A.C. was supported by a Vanderbilt Clinical and Translational Research Scholars award (grant number KL2TR002245) during manuscript development. C.E.B. was supported by a career development award from the National Center for Complementary and Integrative Health during manuscript development (K23AT011569). K.R.A. reports personal fees from NeuroSpinal Innovation Inc. and Spine Journal. The remaining authors report no conflicts of interest.
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