Racial/Ethnic Associations With Morbidity and Mortality in Adults With Acute Traumatic Cervical Spinal Cord Injury.

Abstract

Retrospective cohort study. This study aimed to investigate the association of race with morbidity and mortality in acute cervical spinal cord injury (cSCI) patients. Racial disparities in spine surgery are associated with adverse outcomes, however, the impact of race on cSCI is understudied. We retrospectively reviewed the American College of Surgeons Trauma Quality Programs database to compare outcomes for acute cSCI patients between racial/ethnic identities: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic/Latino (HIS), and other (OTH). Demographics, comorbidities, injury type, treatment modality, and adverse events (AEs) were assessed. Multivariable logistic regression was used to identify independent predictors of AEs, non-routine discharge (NRD), and in-hospital mortality. There were 71,048 patients stratified by race/ethnicity: 44,639 (62.8%) NHW, 13,555 (19.1%) NHB, 5820 (8.2%) HIS, and 7034 (9.9%) OTH. NHB and HIS-identifying patients had the greatest rates of any AE (NHW: 20.7% vs. NHB: 25.0% vs. HIS: 24.6% vs. OTH: 22.0%, P < 0.001) and the longest mean length of stay (NHW: 11.3 ± 13.5 d vs. NHB: 15.5 ± 20.2 d vs. HIS: 15.0 ± 20.5 d vs. OTH: 12.6 ± 17.5 d, P < 0.001). NRDs were lowest for HIS-identifying patients (NHW: 74.8% vs. NHB: 75.5% vs . HIS: 69.5% vs . OTH: 75.4%, P < 0.001), whereas, in-hospital mortality was lowest for NHB-identifying patients (NHW: 12.8% vs . NHB: 10.1% vs . HIS: 12.4% vs . OTH: 13.4%, P < 0.001). On multivariable analyses, NHB odds ratio (OR: 1.16, P < 0.001), HIS (OR: 1.22, P < 0.001), and OTH (OR: 1.14, P = 0.004) cohorts had significantly increased odds of AEs. The NHB cohort had significantly increased odds (OR: 1.25, P < 0.001), whereas, the HIS cohort had significantly decreased odds (OR: 0.78, P = 0.001) of NRD. Only the NHB cohort had significantly decreased odds of in-hospital mortality (OR: 0.69, P <0 .001). Our study suggests there may be racial disparities in outcomes and discharge disposition for acute cSCI patients.