title: Complications and mortality in cervical spine surgery: racial differences.
abstract: METHODS
  Retrospective national database analysis.
  
  
  OBJECTIVE
  Our goal was to estimate racial and ethnic differences in in-hospital complication and mortality rates associated with cervical spine surgery.
  
  
  BACKGROUND
  The impact of observed racial and ethnic disparities in orthopedic spine care use on morbidity and mortality is not well understood.
  
  
  METHODS
  On the basis of the Nationwide Inpatient Sample, there were 983,420 adult nontrauma hospital discharges from 2000 through 2009. In-hospital complications and mortality were the outcome variables. The primary independent variable was race/ethnicity (defined as non-Hispanic white [white], non-Hispanic black [black], and Hispanic). Covariates were age, sex, household income, insurance status, geographical location, hospital volume, and comorbidities. Multivariable regression models were used to determine the association between race/ethnicity and in-hospital complication and mortality. Significance was set at a P value less than 0.05.
  
  
  RESULTS
  The overall rates of an in-hospital complication or mortality were 4.09% and 0.42%, respectively. There were no differences in the rates of in-hospital complications or mortality between Hispanics and Caucasians. Compared with Caucasians, African Americans had higher odds of experiencing an in-hospital complication (odds ratio, 1.37; 95% confidence interval, 1.27-1.48) and higher odds of dying during hospitalization (odds ratio, 1.59; 95% confidence interval, 1.30-1.96).
  
  
  CONCLUSIONS
  Although there were no differences between Caucasians and Hispanics, African Americans had significantly higher rates of in-hospital complications and mortality associated with cervical spine surgery than did Caucasians. These differences persisted after adjusting for known risk factors for complications and mortality.
  
  
  METHODS
  3.
authors.affiliation: *Orthopaedic Surgery †Health Behavior and Society and Hopkins Center for Health Disparities Solutions, and ‡Physical Medicine and Rehabilitation, The Johns Hopkins University, Baltimore, MD.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Skolasky
authors.forename: Roland J
authors.initials: RJ
authors.lastname: Thorpe
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Wegener
authors.forename: Lee H
authors.initials: LH
authors.lastname: Riley
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D017052:Hospital Mortality / Q000208:ethnology; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000379:methods* / Q000401:mortality; D010351:Patient Discharge / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000208:ethnology*; D012189:Retrospective Studies; D044465:White People / Q000706:statistics & numerical data