Racial Disparities in Utilization and Outcomes of Cervical Disc Arthroplasty

Juan Sebastian Arroyave; Mateo Restrepo Mejia; Wasil Ahmed; Rami Rajjoub; Jashvant Poeran; Brocha Z Stern; Saad B Chaudhary

doi:10.1097/BSD.0000000000001714

Racial Disparities in Utilization and Outcomes of Cervical Disc Arthroplasty

Clin Spine Surg. 2024 Nov 6. doi: 10.1097/BSD.0000000000001714. Online ahead of print.

Authors

Juan Sebastian Arroyave¹, Mateo Restrepo Mejia¹, Wasil Ahmed¹, Rami Rajjoub¹, Jashvant Poeran^{1

2}, Brocha Z Stern^{1

2}, Saad B Chaudhary¹

Affiliations

¹ Leni and Peter W. May Department of Orthopaedics.
² Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY.

PMID: 39508849
DOI: 10.1097/BSD.0000000000001714

Abstract

Study design: Retrospective study.

Objective: We examined racial disparities in (1) cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) utilization and (2) CDA in-hospital outcomes.

Summary of background data: ACDF and CDA are established treatments for cervical disc disease. While CDA may offer certain advantages over ACDF, its utilization patterns have not been comprehensively explored.

Methods: This study of 2012 to 2019 discharges from the National Inpatient Sample included White, Black, and Hispanic patients aged 18 years and older who underwent elective ACDF or CDA. Patient demographics, comorbidities, cervical spine diagnoses, and hospital characteristics were extracted. Survey-weighted logistic regression modeled the adjusted association between race and CDA (vs. ACDF) utilization; an interaction between race and year examined temporal changes in disparities. For CDA outcomes, multivariable logistic regression was used for binary outcomes (nonhome discharge, combined complications, and dysphagia) and linear regression for length of stay.

Results: The cohort included 712,355 weighted procedures (97.6% ACDF; 84.2% White, 9.7% Black, 6.1% Hispanic). CDA utilization increased from 1.0% of the procedures in 2012 to 3.8% in 2019. Black and Hispanic patients had significantly lower odds than White patients of receiving CDA versus ACDF (OR=0.77, 95% CI: 0.66-0.89, P=0.001; OR=0.80, 95% CI: 0.69-0.93, P=0.003) respectively. There was no statistically significant interaction between race and discharge year (P=0.50). For in-hospital CDA-specific outcomes, Black (vs. White) patients were more likely to experience dysphagia (OR=2.70, 95% CI: 1.53-4.78, P=0.001) and combined complications (OR=3.10, 95% CI: 1.91-5.05, P <0.001). There were no significant differences in any CDA outcome for Hispanic versus White patients.

Conclusions: This study revealed decreased utilization of CDA versus ACDF in minority patients, a pattern that persisted over time despite overall increasing CDA utilization. In addition, a higher burden of dysphagia and combined complications following CDA in Black patients warrants further examination.

Level of evidence: III.