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Portending Influence of Racial Disparities on Extended Length of Stay after Elective Anterior Cervical Discectomy and Interbody Fusion for Cervical Spondylotic Myelopathy.
World Neurosurg. 2020 Jun 27 [Online ahead of print]WN

Abstract

OBJECTIVE

The aim of this study was to investigate whether race is an independent predictor of extended length of stay (LOS) after elective anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM).

METHODS

A retrospective cohort study was performed using the National Inpatient Sample database from 2016 to 2017. All adult patients undergoing ACDF for CSM were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification coding system.

RESULTS

A total of 15,400 patients were identified, of whom 13,250 (86.0%) were Caucasian (C) and 2150 (14.0%) were African American (AA). The C cohort tended to be older, whereas the AA cohort had 2 times as many patients in the 0-25th income quartile. The prevalence of comorbidities was greater in the AA cohort. Intraoperative fusion levels were similar between the cohorts, whereas the AA cohort had a higher rate of cerebrospinal fluid leak/dural tear. In relation to the number of complications, the C cohort had a lower rate compared with the AA cohort (P = 0.006), including no complication (89.4% vs. 85.3%), 1 complication (9.9% vs. 12.8%), and >1 complication (0.7% vs. 1.9%). The AA cohort experienced significantly longer hospital stays (C, 1.9 ± 2.3 days vs. AA, 2.7 ± 3.5; P < 0.001), greater proportion of extended LOS (C, 17.5% vs. AA, 29.1%; P < 0.001) and nonroutine discharges (C, 16.1% vs. AA, 28.6%; P < 0.001). AA race was a significant independent risk factor for extended LOS (odds ratio, 1.98; 95% confidence interval, 1.50-2.61; P < 0.001).

CONCLUSIONS

Our study suggests that AA patients have a significantly higher risk of prolonged LOS after elective ACDF for CSM compared with C patients.

Authors+Show Affiliations

Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA. Electronic address: aladine.elsamadicy@yale.edu.Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, Maryland, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32599203

Citation

Elsamadicy, Aladine A., et al. "Portending Influence of Racial Disparities On Extended Length of Stay After Elective Anterior Cervical Discectomy and Interbody Fusion for Cervical Spondylotic Myelopathy." World Neurosurgery, 2020.
Elsamadicy AA, Koo AB, David WB, et al. Portending Influence of Racial Disparities on Extended Length of Stay after Elective Anterior Cervical Discectomy and Interbody Fusion for Cervical Spondylotic Myelopathy. World Neurosurg. 2020.
Elsamadicy, A. A., Koo, A. B., David, W. B., Sarkozy, M., Freedman, I. G., Reeves, B. C., Laurans, M., Kolb, L., & Sciubba, D. M. (2020). Portending Influence of Racial Disparities on Extended Length of Stay after Elective Anterior Cervical Discectomy and Interbody Fusion for Cervical Spondylotic Myelopathy. World Neurosurgery. https://doi.org/10.1016/j.wneu.2020.06.155
Elsamadicy AA, et al. Portending Influence of Racial Disparities On Extended Length of Stay After Elective Anterior Cervical Discectomy and Interbody Fusion for Cervical Spondylotic Myelopathy. World Neurosurg. 2020 Jun 27; PubMed PMID: 32599203.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Portending Influence of Racial Disparities on Extended Length of Stay after Elective Anterior Cervical Discectomy and Interbody Fusion for Cervical Spondylotic Myelopathy. AU - Elsamadicy,Aladine A, AU - Koo,Andrew B, AU - David,Wyatt B, AU - Sarkozy,Margot, AU - Freedman,Isaac G, AU - Reeves,Benjamin C, AU - Laurans,Maxwell, AU - Kolb,Luis, AU - Sciubba,Daniel M, Y1 - 2020/06/27/ PY - 2020/05/14/received PY - 2020/06/17/revised PY - 2020/06/19/accepted PY - 2020/7/1/pubmed PY - 2020/7/1/medline PY - 2020/6/30/entrez KW - Anterior cervical discectomy and fusion KW - Cervical spondylotic myelopathy KW - Extended length of stay KW - Racial disparities JF - World neurosurgery JO - World Neurosurg N2 - OBJECTIVE: The aim of this study was to investigate whether race is an independent predictor of extended length of stay (LOS) after elective anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM). METHODS: A retrospective cohort study was performed using the National Inpatient Sample database from 2016 to 2017. All adult patients undergoing ACDF for CSM were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification coding system. RESULTS: A total of 15,400 patients were identified, of whom 13,250 (86.0%) were Caucasian (C) and 2150 (14.0%) were African American (AA). The C cohort tended to be older, whereas the AA cohort had 2 times as many patients in the 0-25th income quartile. The prevalence of comorbidities was greater in the AA cohort. Intraoperative fusion levels were similar between the cohorts, whereas the AA cohort had a higher rate of cerebrospinal fluid leak/dural tear. In relation to the number of complications, the C cohort had a lower rate compared with the AA cohort (P = 0.006), including no complication (89.4% vs. 85.3%), 1 complication (9.9% vs. 12.8%), and >1 complication (0.7% vs. 1.9%). The AA cohort experienced significantly longer hospital stays (C, 1.9 ± 2.3 days vs. AA, 2.7 ± 3.5; P < 0.001), greater proportion of extended LOS (C, 17.5% vs. AA, 29.1%; P < 0.001) and nonroutine discharges (C, 16.1% vs. AA, 28.6%; P < 0.001). AA race was a significant independent risk factor for extended LOS (odds ratio, 1.98; 95% confidence interval, 1.50-2.61; P < 0.001). CONCLUSIONS: Our study suggests that AA patients have a significantly higher risk of prolonged LOS after elective ACDF for CSM compared with C patients. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/32599203/Portending_Influence_Racial_Disparities_has_on_Extended_Length_of_Stay_after_Elective_Anterior_Cervical_Discectomy_and_Interbody_Fusion_for_Cervical_Spondylotic_Myelopathy L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(20)31423-6 DB - PRIME DP - Unbound Medicine ER -
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