• Hammad A Khan, Nicholas M Rabah, Vikram Chakravarthy, Raghav Tripathi, and Ajit A Krishnaney.
• Case Western Reserve University School of Medicine, Cleveland, OH.
• Spine. 2021 Dec 15; 46 (24): E1334E1342E1334-E1342.

Study DesignSecondary analysis of a national all-payer database.ObjectiveOur objectives were to identify patient- and hospital-level factors independently associated with the receipt of nonelective surgery and determine whether nonelective surgery portends differences in perioperative outcomes compared to elective surgery for spinal metastases.Summary Of Background DataSpinal metastases may progress to symptomatic epidural spinal cord compression that warrants urgent surgical intervention. Although nonelective surgery for spinal metastases has been associated with poor postoperative outcomes, literature evaluating disparities in the receipt of nonelective versus elective surgery in this population is lacking.MethodsThe National Inpatient Sample (2012-2015) was queried for patients who underwent surgical intervention for spinal metastases. Multivariable logistic regression models were constructed to evaluate the association of patient- and hospital-level factors with the receipt of nonelective surgery, as well as to evaluate the influence of admission status on perioperative outcomes.ResultsAfter adjusting for disease-related factors and other baseline covariates, our multivariable logistic regression model revealed several sociodemographic differences in the receipt of nonelective surgery. Patients of black (odds ratio [OR] = 1.38, 95% confidence interval [CI]: 1.03-1.84, P = 0.032) and other race (OR = 1.50, 95% CI: 1.13-1.98, P = 0.005) had greater odds of undergoing nonelective surgery than their white counterparts. Patients of lower income (OR = 1.40, 95% CI: 1.06-1.84, P = 0.019) and public insurance status (OR = 1.56, 95% CI: 1.26-1.93, P < 0.001) were more likely to receive nonelective surgery than higher income and privately insured patients, respectively. Higher comorbidity burden was also associated with greater odds of non-elective admission (OR = 2.94, 95% CI: 2.07-4.16, P  < 0.001). With respect to perioperative outcomes, multivariable analysis revealed that patients receiving nonelective surgery were more likely to experience nonroutine discharge (OR = 2.50, 95% CI: 2.09-2.98, P  < 0.001) and extended length of stay [LOS] (OR = 2.45, 95% CI: 1.91-3.16, P < 0.001).ConclusionThe present study demonstrates substantial disparities in the receipt of nonelective surgery across sociodemographic groups and highlights its association with nonroutine discharge and extended LOS.Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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