Racial Disparities in Utilization and Outcomes of Cervical Disc Arthroplasty.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2024-11-06 DOI:10.1097/BSD.0000000000001714

Juan Sebastian Arroyave, Mateo Restrepo Mejia, Wasil Ahmed, Rami Rajjoub, Jashvant Poeran, Brocha Z Stern, Saad B Chaudhary

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Abstract

Study design: Retrospective study.

Objective: We examined racial disparities in (1) cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) utilization and (2) CDA in-hospital outcomes.

Summary of background data: ACDF and CDA are established treatments for cervical disc disease. While CDA may offer certain advantages over ACDF, its utilization patterns have not been comprehensively explored.

Methods: This study of 2012 to 2019 discharges from the National Inpatient Sample included White, Black, and Hispanic patients aged 18 years and older who underwent elective ACDF or CDA. Patient demographics, comorbidities, cervical spine diagnoses, and hospital characteristics were extracted. Survey-weighted logistic regression modeled the adjusted association between race and CDA (vs. ACDF) utilization; an interaction between race and year examined temporal changes in disparities. For CDA outcomes, multivariable logistic regression was used for binary outcomes (nonhome discharge, combined complications, and dysphagia) and linear regression for length of stay.

Results: The cohort included 712,355 weighted procedures (97.6% ACDF; 84.2% White, 9.7% Black, 6.1% Hispanic). CDA utilization increased from 1.0% of the procedures in 2012 to 3.8% in 2019. Black and Hispanic patients had significantly lower odds than White patients of receiving CDA versus ACDF (OR=0.77, 95% CI: 0.66-0.89, P=0.001; OR=0.80, 95% CI: 0.69-0.93, P=0.003) respectively. There was no statistically significant interaction between race and discharge year (P=0.50). For in-hospital CDA-specific outcomes, Black (vs. White) patients were more likely to experience dysphagia (OR=2.70, 95% CI: 1.53-4.78, P=0.001) and combined complications (OR=3.10, 95% CI: 1.91-5.05, P <0.001). There were no significant differences in any CDA outcome for Hispanic versus White patients.

Conclusions: This study revealed decreased utilization of CDA versus ACDF in minority patients, a pattern that persisted over time despite overall increasing CDA utilization. In addition, a higher burden of dysphagia and combined complications following CDA in Black patients warrants further examination.

Level of evidence: III.

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颈椎椎间盘关节置换术的使用和结果中的种族差异。

研究设计回顾性研究：我们研究了（1）颈椎间盘关节置换术（CDA）与颈椎前路椎间盘切除融合术（ACDF）使用率的种族差异，以及（2）CDA的院内治疗效果：ACDF 和 CDA 是治疗颈椎间盘疾病的成熟疗法。虽然CDA可能比ACDF具有某些优势，但其使用模式尚未得到全面探讨：本研究对 2012 年至 2019 年全国住院病人样本的出院病例进行了研究，包括接受选择性 ACDF 或 CDA 治疗的 18 岁及以上白人、黑人和西班牙裔病人。研究提取了患者的人口统计学特征、合并症、颈椎诊断和医院特征。调查加权逻辑回归模拟了种族与CDA（与 ACDF）使用率之间的调整关系；种族与年份之间的交互作用检验了差异的时间变化。对于CDA结果，二元结果（非家庭出院、合并并发症和吞咽困难）采用多变量逻辑回归，住院时间采用线性回归：队列包括 712,355 例加权手术（97.6% 为 ACDF；84.2% 为白人，9.7% 为黑人，6.1% 为西班牙裔）。CDA使用率从2012年的1.0%增至2019年的3.8%。黑人和西班牙裔患者接受 CDA 与 ACDF 的几率分别显著低于白人患者（OR=0.77，95% CI：0.66-0.89，P=0.001；OR=0.80，95% CI：0.69-0.93，P=0.003）。种族与出院年份之间没有统计学意义上的交互作用（P=0.50）。就院内 CDA 特异性结果而言，黑人（与白人相比）患者更有可能出现吞咽困难（OR=2.70，95% CI：1.53-4.78，P=0.001）和合并并发症（OR=3.10，95% CI：1.91-5.05，P 结论：本研究显示，尽管CDA的使用率总体呈上升趋势，但少数族裔患者对CDA的使用率较ACDF有所下降，而且这种情况会随着时间的推移而持续。此外，黑人患者在CDA术后出现吞咽困难和合并并发症的几率更高，值得进一步研究：证据等级：III。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.