Study Design:

This was a retrospective chart review.

Objective:

The objective of this study was to examine disparities within patients undergoing anterior cervical discectomy and fusion (ACDF) at a multi-site tertiary referral center with specific focus on factors related to length of stay (LOS).

Summary of Background Data:

There are previously described racial disparities in spinal surgery outcomes and quality metrics.

Methods:

A total of 278 consecutive patients undergoing ACDF by 8 different surgeons over a 5-year period were identified retrospectively. Demographic data, including age at time of surgery, sex, smoking status, and self-identified race [White or African American (AA)], as well as surgical data and postoperative course were recorded. Preoperative health status was recorded, and comorbidities were scored by the Charlson Comorbidity Index. Univariable and multivariable linear regression models were employed to quantify the degree to which a patient’s LOS was related to their self-identified race, demographics, and perioperative clinical data.

Results:

Of the 278 patients who received an ACDF, 71.6%(199) self-identified as White and 28.4%(79) identified as AA. AA patients were more likely to have an ACDF due to myelopathy, while White patients were more likely to have an ACDF due to radiculopathy (P= 0.001). AA patients had longer LOS by an average of half a day (P= 0.001) and experienced a larger percentage of extended stays (P= 0.002). AA patients experienced longer overall operation times on average (P= 0.001) across all different levels of fusion. AA race was not an independent driver of LOS (β= 0.186; P= 0.246).

Conclusions:

As hypothesized, and consistent with previous literature on racial surgical disparities, AA race was associated with increased LOS, increased operative times, and increased indication of myelopathy in this study. Additional research is necessary to evaluate the underlying social determinants of health and other factors that may contribute to this study’s results.

Level of Evidence:

Level III.

Anterior cervical discectomy and fusion (ACDF) is one of the most common cervical spine procedures and is typically performed for treatment of cervical disk disease resulting from pressure of the spinal cord, myelopathy, pressure of a nerve root, radiculopathy, or a combination of the 2. 1 Health care costs related to ACDF surgery have been previously analyzed to minimize surgical costs due to the high volume of ACDFs performed annually. 2 One identified driver of elevated cost is extended length of stay (LOS). Nationally, LOS is a surrogate marker for quality of care delivered across medical and surgical fields and is related to clinical, nonclinical, and system-level aspects of postsurgical care. 3