• World Neurosurg · Oct 2020

    Portending Influence Racial Disparities has on Extended Length of Stay after Elective Anterior Cervical Discectomy and Interbody Fusion for Cervical Spondylotic Myelopathy.

    • Aladine A Elsamadicy, Andrew B Koo, Wyatt B David, Margot Sarkozy, Isaac G Freedman, Benjamin C Reeves, Maxwell Laurans, Luis Kolb, and Daniel M Sciubba.
    • Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA. Electronic address: aladine.elsamadicy@yale.edu.
    • World Neurosurg. 2020 Oct 1; 142: e173-e182.

    ObjectiveThe 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).MethodsA 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.ResultsA 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).ConclusionsOur study suggests that AA patients have a significantly higher risk of prolonged LOS after elective ACDF for CSM compared with C patients.Copyright © 2020 Elsevier Inc. All rights reserved.

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