• Andrew J Schoenfeld, Tajdip Sandhu, Daniel J Sturgeon, Kenneth Nwosu, and Christopher M Bono.
• Center for Surgery and Public Health, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
• Spine. 2017 Dec 15; 42 (24): 191719221917-1922.

Study DesignThis was a retrospective review of the Florida Inpatient Dataset (2011-2014).ObjectiveTo examine healthcare segregation among African American and Hispanic patients treated with one of four common spine surgical procedures.Summary Of Background DataRacial and ethnic minorities are known to be at increased risk of adverse events after spine surgery. Healthcare segregation has been proposed as a source for these disparities, but has not been systematically examined for patients undergoing spine surgery.MethodsAfrican American, Hispanic, and White patients who underwent one of the four lumbar spine surgical procedures under study were included. Volume cut-offs were previously established for surgical providers and hospitals. Surgeons and hospitals were dichotomized based on these metrics as low- or high-volume providers. Multivariable logistic regression analysis was used to determine the likelihood of patients receiving surgery from a low volume provider, adjusting for sociodemographic and clinical characteristics.ResultsAfrican Americans were found to be at significantly increased odds of receiving surgery from a low-volume surgeon (P < 0.001) and were significantly more likely to receive surgery at a low-volume hospital (P < 0.007) for all procedures except decompression (P = 0.56). Like findings were encountered for Hispanic patients. Hispanic patients were 55% to three-times more likely to receive surgery from a low-volume surgeon depending on the procedure and 28% to 56% more likely to be treated at a low-volume hospital. African Americans were 34% to 82% more likely to receive surgery from a low-volume surgeon depending on the procedure and 10% to 17% more likely to be treated at a low-volume hospital.ConclusionThe results of this work identify the phenomenon of racial and ethnic healthcare segregation among low-volume providers for lumbar spine procedures in the State of Florida. This may be a contributing factor to the increased risk of adverse events after spine surgery known to exist among minorities.Level Of Evidence3.

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