A Comparison of Inpatient Versus Ambulatory Lumbar Surgical Care Utilization Among Minority Patients.

Abstract

Retrospective cohort study. Identify and compare racial/ethnic disparities in ambulatory versus inpatient surgical care utilization for single-level lumbar spine surgery. The proportion of spine surgeries performed in the ambulatory setting has dramatically increased over the past 2 decades. However, few studies have investigated whether this shift has resulted in racial/ethnic disparities in surgical care utilization, particularly for outpatient lumbar spine surgery, compared with the inpatient setting. Utilizing the 2019 National Inpatient Sample and Nationwide Ambulatory Surgical Sample discharge, we included patients who had undergone a single-level lumbar discectomy, laminectomy, and/or fusion, were of Black, White, or Hispanic race/ethnicity, were covered under Medicare, Medicaid, or private insurance, and were aged 18 years or above. The primary outcome was the rate ratio (RR) of patients from the aforementioned 3 racial/ethnic groups undergoing lumbar surgical care, in the ambulatory and inpatient settings. US Bureau of Labor Statistics data were utilized to offset the model for population-based variations in sociodemographic factors utilizing nested coefficients. Among 397,173 cases, 220,250 (55.5%) were inpatient, and 176,923 (44.5%) were ambulatory. Compared with White patients, Black (RR: 0.54, 95% CI: 0.53-0.55) and Hispanic (RR: 0.61, 95% CI: 0.60-0.62) patients had lower utilization rates of ambulatory surgical care. More pronounced patterns were observed for Black (RR: 0.44 95% CI: 0.44-0.45) and Hispanic (RR: 0.55, 95% CI: 0.54-0.56) inpatient surgical utilization; all P < 0.001. Racial/ethic disparities in single-level lumbar surgical care utilization exist in both the ambulatory and the inpatient setting. Level 3.