Addressing Healthcare Disparities in Patients Undergoing Cervical Spine Surgery

INTRODUCTION: Health disparities may be observed across pre and post-operative hospital courses amongst patients undergoing cervical spine surgery across racial minorities and their white counterparts. METHODS: Retrospective data analysis of the Thomas Jefferson University Center City Department of Neurosurgery undergoing cervical spine surgeries (based on select CPT codes) between January 1, 2018, and January 6, 2021, was conducted to evaluate healthcare disparities across the post-operative management of cervical myelopathy cases as part of a quality improvement initiative. Outcomes evaluated included: hospital length of stay, the 30-day hospital readmission rate, and discharge disposition (home vs non-home). Normality was assessed using Kolmogorov-Smirnov test. Readmission rates, length of stay (LOS) in days, and discharge disposition (DD) (home vs. non-home) were analyzed using the Student's T-test, ANOVA, and Mann-Whitney test. RESULTS: Two thousand twenty-five patients were identified that met inclusion criteria, of which 298 (15%) were readmitted within 30 days to the Emergency Department at Thomas Jefferson University Hospital. Of the 15% readmitted, 74% (223/298) were white, while 25% (75/298) were non-white. Non-white LOS was higher compared to the white population (5.7 days vs 4.3 days, p < 0.0001. Non-white readmission rate was higher compared to the white population (22.3% vs 16%) p < 0.001. Non-white DD was higher compared to the white population (61.9% vs 50%) p < 0.001. CONCLUSIONS: Significant disparities exist in the post-operative management of patients with cervical myelopathy, particularly affecting the non-white population. Health disparities exist across multiple aspects of the discharge process for post-cervical spine surgery cases. Future investigations and interventions are required to address this quality gap.