Racial Disparities in Surgical Outcomes After Spine Surgery for Spinal Epidural Abscess

Introduction: Investigation into the effect of demographic identifiers, such as race and socioeconomic status, on health outcomes has risen to the forefront of research across medical disciplines attempting to understand the complex interplay of factors that lead to health disparities. This study aims to identify racial disparities in outcomes following spine surgery for spinal epidural abscess (SEA).

Methods: We conducted a retrospective cohort study using the 2011-2022 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database to identify adult patients who underwent spinal surgery for spinal epidural abscess. The study population was stratified by race and ethnicity into four groups: non-Hispanic White(NHW), non-Hispanic Black(NHB), Hispanic(HIS), and Other(OTH). Multivariable logistic regression analyses were performed to identify factors associated with extended length of stay (LOS), adverse events (AEs), non-routine discharge (NRD), 30-day unplanned reoperation, and mortality.

Results: Of the 1,654 adult patients, 1198 (72.4%) identified as NHW, 184 (11.1%) identified as NHB, 188 (11.4%) identified as HIS, and 84 (5.1%) identified as OTH. The NHB cohort had the highest proportion of individuals with mFI-5 scores > 2 (NHW: 26.9% vs. NHB: 39.1% vs. Hispanic: 27.7% vs. Other: 34.5%, p=0.002). No significant difference in rates of 30-day AEs, LOS, operation time, NRD, 30-day reoperation, or mortality were noted between the groups. On both univariate (1.80 (1.10-2.93), p=0.019) and multivariate (2.48 (1.41-4.38), p=0.002) analysis, the OTH cohort was associated with significantly higher risk of extended hospitalization. There were no other significant associations between cohort and risk for AEs, NRD, 30-day reoperation, or mortality.

Conclusion : Our study suggests racial disparities in comorbidities, as defined by the mFI-5 scale, but does not indicate disparities in post-surgical outcomes for SEA patients. Further studies are needed to evaluate the potential for racial disparities in outcomes and better understand how disparities in comorbidities can affect post-surgical results for SEA.