TY - JOUR
T1 - Racial Differences in Perioperative Complications, Readmissions, and Mortalities After Elective Spine Surgery in the United States
T2 - A Systematic Review Using AI-Assisted Bibliometric Analysis
AU - Akosman, Izzet
AU - Kumar, Neerav
AU - Mortenson, Richard
AU - Lans, Amanda
AU - De La Garza Ramos, Rafael
AU - Eleswarapu, Ananth
AU - Yassari, Reza
AU - Fourman, Mitchell S.
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2024/3
Y1 - 2024/3
N2 - Study Design: Systematic Review and Meta-analysis. Objectives: To evaluate the impact of race on post-operative outcomes and complications following elective spine surgery in the United States. Methods: PUBMED, MEDLINE(R), ERIC, EMBASE, and SCOPUS were searched for studies documenting peri-operative events for White and African American (AA) patients following elective spine surgery. Pooled odds ratios were calculated for each 90-day outcome and meta-analyses were performed for 4 peri-operative events and 7 complication categories. Sub-analyses were performed for each outcome on single institution (SI) studies and works that included <100,000 patients. Results: 53 studies (5,589,069 patients, 9.8% AA) were included. Eleven included >100,000 patients. AA patients had increased rates of 90-day readmission (OR 1.33, P =.0001), non-routine discharge (OR 1.71, P =.0001), and mortality (OR 1.66, P =.0003), but not re-operation (OR 1.16, P =.1354). AA patients were more likely to have wound-related complications (OR 1.47, P =.0001) or medical complications (OR 1.35, P =.0006), specifically cardiovascular (OR 1.33, P =.0126), deep vein thrombosis/pulmonary embolism (DVT/PE) (OR 2.22, P =.0188) and genitourinary events (OR 1.17, P =.0343). SI studies could only detect racial differences in re-admissions and non-routine discharges. Studies with <100,000 patients replicated the above findings but found no differences in cardiovascular complications. Disparities in mortality were only detected when all studies were included. Conclusions: AA patients faced a greater risk of morbidity across several distinct categories of peri-operative events. SI studies can be underpowered to detect more granular complication types (genitourinary, DVT/PE). Rare events, such as mortality, require larger sample sizes to identify significant racial disparities.
AB - Study Design: Systematic Review and Meta-analysis. Objectives: To evaluate the impact of race on post-operative outcomes and complications following elective spine surgery in the United States. Methods: PUBMED, MEDLINE(R), ERIC, EMBASE, and SCOPUS were searched for studies documenting peri-operative events for White and African American (AA) patients following elective spine surgery. Pooled odds ratios were calculated for each 90-day outcome and meta-analyses were performed for 4 peri-operative events and 7 complication categories. Sub-analyses were performed for each outcome on single institution (SI) studies and works that included <100,000 patients. Results: 53 studies (5,589,069 patients, 9.8% AA) were included. Eleven included >100,000 patients. AA patients had increased rates of 90-day readmission (OR 1.33, P =.0001), non-routine discharge (OR 1.71, P =.0001), and mortality (OR 1.66, P =.0003), but not re-operation (OR 1.16, P =.1354). AA patients were more likely to have wound-related complications (OR 1.47, P =.0001) or medical complications (OR 1.35, P =.0006), specifically cardiovascular (OR 1.33, P =.0126), deep vein thrombosis/pulmonary embolism (DVT/PE) (OR 2.22, P =.0188) and genitourinary events (OR 1.17, P =.0343). SI studies could only detect racial differences in re-admissions and non-routine discharges. Studies with <100,000 patients replicated the above findings but found no differences in cardiovascular complications. Disparities in mortality were only detected when all studies were included. Conclusions: AA patients faced a greater risk of morbidity across several distinct categories of peri-operative events. SI studies can be underpowered to detect more granular complication types (genitourinary, DVT/PE). Rare events, such as mortality, require larger sample sizes to identify significant racial disparities.
KW - complications
KW - disparities
KW - outcomes
KW - race
KW - spine surgery
UR - http://www.scopus.com/inward/record.url?scp=85164110386&partnerID=8YFLogxK
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U2 - 10.1177/21925682231186759
DO - 10.1177/21925682231186759
M3 - Review article
AN - SCOPUS:85164110386
SN - 2192-5682
VL - 14
SP - 750
EP - 766
JO - Global Spine Journal
JF - Global Spine Journal
IS - 2
ER -