title: Racial disparities in outcomes of spinal surgery for lumbar stenosis.
abstract: METHODS
  A retrospective, cross-sectional study.
  
  
  OBJECTIVE
  To evaluate racial disparities in outcomes of lumbar stenosis surgery.
  
  
  BACKGROUND
  Racial inequalities have been described in the outcomes of cardiovascular and orthopedic procedures. There have been minimal investigation of racial disparities in complications and costs of lumbar laminectomies and fusions.
  
  
  METHODS
  We analyzed the Medicaid data set of Thomson Reuter's MarketScan database. African-American and non-Hispanic white patients who underwent laminectomy or fusion for lumbar stenosis with at least 2 years postoperative data were included. We examined the effect of race on the rate of reoperations, complications, and the cost associated with surgery.
  
  
  RESULTS
  African-American patients in the Medicaid database were at no higher risk for reoperation in the 2 years after an operation for lumbar stenosis than white patients (7.14% vs. 7.89%, P = 0.7895). However, we did find that African-American patients were more likely to experience postoperative complications of any kind, even after adjusting for length of hospital stay, comorbidities, sex, and age (adjusted odds ratio = 1.819, P = 0.0123 for immediate complication; adjusted odds ratio = 1.746, P = 0.0141 for 30-d complication; and adjusted odds ratio = 1.611, P = 0.0410 for 90-d complication). White patients had a significantly shorter length of stay (3 vs. 5 d, P < 0.007) and accrued fewer hospital-related costs ($16,148 vs. $24,267, P < 0.0007). African-American patients, despite having more comorbidities in our sample, were prescribed significantly fewer medications in the 2 years after index procedures (91 vs. 138 prescriptions, P < 0.0007) and had fewer medication costs during the 2 years after surgery ($5297 vs. $8450, P < 0.0007).
  
  
  CONCLUSIONS
  At the national level, there are several racial disparities in the rate of complications, length of stay, and costs after surgery for lumbar spinal stenosis.
  
  
  METHODS
  3.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. nandan.lad@duke.edu
authors.forename: Shivanand P
authors.initials: SP
authors.lastname: Lad
authors.forename: Jacob H
authors.initials: JH
authors.lastname: Bagley
authors.forename: Krista T
authors.initials: KT
authors.lastname: Kenney
authors.forename: Beatrice
authors.initials: B
authors.lastname: Ugiliweneza
authors.forename: Maiying
authors.initials: M
authors.lastname: Kong
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Bagley
authors.forename: Oren N
authors.initials: ON
authors.lastname: Gottfried
authors.forename: Robert E
authors.initials: RE
authors.lastname: Isaacs
authors.forename: Chirag G
authors.initials: CG
authors.lastname: Patil
authors.forename: Maxwell
authors.initials: M
authors.lastname: Boakye
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D007796:Laminectomy / Q000191:economics / Q000379:methods*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000191:economics / Q000208:ethnology; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000191:economics / Q000379:methods*; D013130:Spinal Stenosis / Q000208:ethnology / Q000601:surgery*; D014481:United States; D044465:White People / Q000706:statistics & numerical data