title: Outcomes after spine surgery among racial/ethnic minorities: a meta-analysis of the literature.
abstract: BACKGROUND
  Prior research has identified disparities in access to care, resource utilization, and outcomes in members of racial and ethnic minorities. However, the role that race/ethnicity may play in influencing outcomes after spine surgery has not been previously studied.
  
  
  OBJECTIVE
  To characterize the effect of race and ethnicity on outcome after spine surgery.
  
  
  METHODS
  Systematic literature review and meta-analysis.
  
  
  METHODS
  Of 11 investigations selected in the initial analysis, four reported results in a fashion that enabled their inclusion in the meta-analysis. These four studies included a total of 128,635 patients.
  
  
  METHODS
  "Favorable" or "unfavorable" postsurgical outcomes were determined based on parameters described in each included investigation.
  
  
  METHODS
  A systematic literature review was performed to identify all studies documenting outcomes, complications, or mortality after spine surgical procedures. Eligible studies had to include raw data that enabled separate analysis of white and nonwhite patients. Outcome was categorized as "favorable" or "unfavorable" based on scales included in each investigation. The Q-statistic was used to determine heterogeneity, and a meta-analysis was performed to assess the relative risk for unfavorable outcome among nonwhite patients after spine surgery.
  
  
  RESULTS
  Eleven studies met initial selection criteria but only four were eligible for inclusion in the meta-analysis. The meta-analysis included 128,635 patients among whom 12,194 (9.5%) had unfavorable outcomes. Among white patients, 9.4% sustained an unfavorable outcome as compared with 10.4% of nonwhites.
  
  
  CONCLUSIONS
  In light of the small number of studies able to be included in the meta-analysis, no firm conclusions can be drawn regarding the effect of race/ethnicity on outcome after spinal surgery. There is a pressing need for more robust research regarding spine surgical outcomes among different racial and ethnic minority groups.
authors.affiliation: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, 5005 N. Piedras St., El Paso, TX 79920, USA. ajschoen@neoucom.edu
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schoenfeld
authors.forename: Ryan N
authors.initials: RN
authors.lastname: Sieg
authors.forename: Gang
authors.initials: G
authors.lastname: Li
authors.forename: Julia O
authors.initials: JO
authors.lastname: Bader
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Belmont
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bono
mesh_terms: D005006:Ethnicity; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data; D006801:Humans; D011183:Postoperative Complications / Q000208:ethnology*; D013122:Spinal Diseases / Q000208:ethnology* / Q000601:surgery*; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome