title: Race as an Independent Predictor of Temporal Delay in Time to Diagnosis and Treatment in Patients with Cervical Stenosis: A Study of 133 Patients with Anterior Cervical Discectomy and Fusion.
abstract: BACKGROUND
  Prompt decompression in clinically significant cervical stenosis is important in the prevention of neurological sequelae. Disparities exist along the continuum on spine care, with black patients receiving less surgery and experiencing worse postoperative outcomes. The aim of this study was to assess whether black race was an independent predictor for a prolonged time to diagnosis and treatment.
  
  
  METHODS
  The medical records of 133 patients undergoing elective anterior cervical discectomy and fusion surgery at a major academic medical center between 2010 and 2012 were reviewed. All patients had prospectively collected patient-reported outcomes measures including visual analogue scale (VAS) of pain. Data on patient demographics, comorbidities, and postoperative complication rates were retrospectively collected. Multivariate analysis was performed on variables that trended with delay in diagnosis and treatment on univariate analysis to determine independent predictors of delay in diagnosis and treatment.
  
  
  RESULTS
  Patient demographics of the cohort included 45.87% male, 80.30% white, 71.97% married, 53.72% employed, 18.8% with a history of depression, and 19.55% with anxiety. The mean ± standard deviation age was 54.02 ± 11.74 years and baseline VAS-neck pain was 4.87 ± 3.19. In a multivariate analysis, race was the only statistically significant variable (P = 0.0212) to predict increased duration of preoperative pain before treatment. Other variables in the model included depression, anxiety, age, gender, employment status, marital status, body mass index, and baseline VAS-neck pain score.
  
  
  CONCLUSIONS
  Our study demonstrates that race is an independent risk factor for a temporal delay in diagnosis and treatment of symptomatic cervical stenosis.
authors: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors: Aladine A
authors: AA
authors: Elsamadicy
authors: Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA. Electronic address: owoicho.adogwa@gmail.com.
authors: Owoicho
authors: O
authors: Adogwa
authors: Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
authors: Jared
authors: J
authors: Fialkoff
authors: Department of Neurosurgery, The University of Illinois at Chicago, Chicago, Illinois, USA.
authors: Ankit I
authors: AI
authors: Mehta
authors: Department of Neurosurgery, University of Kentucky Medical Center, Lexington, Kentucky, USA.
authors: Raul A
authors: RA
authors: Vasquez
authors: Department of Neurosurgery, Yale University Medical Center, New Haven, Connecticut, USA.
authors: Joseph
authors: J
authors: Cheng
authors: Department of Neurosurgery, University of Texas South Western, Dallas, Texas, USA.
authors: Carlos A
authors: CA
authors: Bagley
authors: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors: Isaac O
authors: IO
authors: Karikari
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D002574:Cervical Vertebrae; D019299:Decompression, Surgical; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D003863:Depression / Q000453:epidemiology; D017586:Diskectomy; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data
keywords: Complications; Independent predictor; Multivariate analysis; Patient-reported outcomes; Race; Spine surgery