Race can impact hospital length of stay after elective spine surgery

African-American patients may have a lengthier hospital stay than Caucasian patients after elective spine surgery.

BOSTON — Patients’ race had a definite impact on their length of hospital stay after elective spine surgery, according to data presented at the Congress of Neurological Surgeons Annual Meeting.

Andreea Seicean, MPH, PhD, who presented the findings at the meeting, and colleagues analyzed 48,493 adult patients who underwent elective laminectomy and/or fusion from 2006 to 2012 at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. The study was a retrospective cohort analysis of prospectively collected clinical data from 374 U.S. institutions.

Andreea Seicean

“The aim of our study was to assess the effect of race on outcomes in patients undergoing elective laminectomy or fusion,” Seicean said.

A difference in race

Seicean and colleagues used propensity scores to match Caucasian and non-Caucasian patients for all preoperative and intraoperative factors. They then, according to details of the study, used regular and conditional logistic regression to predict the effect of race on adverse postoperative outcomes in the full sample and the matched sample. Seicean then used the same methodology to compare Caucasian and African-American patients, who comprised 39% of minority patients included in the study

The investigators excluded patients who had missing data for race or preoperative septic shock, as well as those patients who underwent a preoperative transfusion.

In the study, 82% of patients were Caucasian, but there were no differences in preoperative and intraoperative factors when white patients were compared with all minority patients, according to Seicean. However, when comparing African-American to Caucasian patients, African-American were found to have higher rates of diabetes, hypertension and anemia. The patients’ 30-day outcomes were also compared by race.

Length of stay differences

According to the results, compared with Caucasian, all minority patients had slight increases in the odds for a prolonged length of hospitalization and for discharge with continued care. When limiting the study sample to African-American and Caucasian patients alone, African-American patients were found to have significantly longer average length of hospital stay, a greater number of complications, as well as more frequent unexpected return to the operating room, and discharge with continued care (nursing home, rehabilitation facility, or other non-home destination) compared with Caucasian patients.

After taking into account differences in baseline characteristics by employing propensity analysis to match patients one-to-one with respect to preoperative and intra-operative variables, Seicean reported that African-American race continued to be associated with prolonged length of hospital stay, complications and discharge with continued care.

“We found that the African-American race is associated with around twice the odds of prolonged length of stay and discharge with continued care,” Seicean said. “We found slightly higher odds of major complications when comparing African-American to Caucasian patients with the same baseline comorbidities, undergoing the same type of surgery for the same diagnosis.”

She said additional studies are needed to understand the reasons behind racial differences in elective spine surgery outcomes and to further address ways to improve the quality of care for all spine surgery patients. – by Robert Linnehan

Reference:

Seicean A. Paper #142. Presented at: Congress of Neurological Surgeons Annual Meeting; Oct. 18-22, 2014; Boston.

For more information:

Andreea Seicean, MPH, PhD, can be reached at the Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, 10900 Euclid Ave., Cleveland, OH 44106-4945; email: aas33@case.edu.

Disclosure: Seicean has no relevant financial disclosures.