Disparity in resource utilization of motion-sparing anterior cervical spine surgery: an analysis of NSQIP® and PearlDiver® database.

BACKGROUND

Widespread racial, gender-related, socioeconomic and insurance-related disparities have been widely implicated in the utilization of new and improved surgical techniques including various aspects spinal surgery. A comprehensive analysis of such disparities is lacking for motion-preserving techniques in cervical spine surgery.

PURPOSE: To explore the disparities in resource utilization of motion-sparing technology in cervical spine surgery.

STUDY DESIGN/

SETTING

Retrospective review of large database.

PATIENT SAMPLE: NSQIP® database from 2010 to 2021 and PearlDiver® database from 2010 to 2022 were queried. CPT codes for cervical disc arthroplasty (CDA), and anterior cervical discectomy and fusion (ACDF) were utilized to isolate the case records (Table 1 and 3).

OUTCOME MEASURES: Preoperative clinical, racial, and gender data were investigated utilizing NSQIP®. PearlDiver® was used for area-level family income, education, insurance status and unemployment.

METHODS

Chi-square, Kruskal-Wallis and logistic regression were used for univariable categorical, continuous and multivariable analyses, respectively.

RESULTS

A total of 5,912 and 32,625 CDA cases and 69,701 and 526,851 ACDF cases were isolated from NSQIP® and PearlDiver®, respectively. 'Younger' age, 'Asian Pacific Islander' race and elective surgery (p<.001), were associated with undergoing CDA in NSQIP® database. Presence of Type 1 diabetes, smoking and hypertension (HTN) (p<.001) were associated with undergoing ACDF in NSQIP®. PearlDiver® database showed 'Younger' age, higher area-level 'Family Income', and a higher mean percent of patients with 'private health insurance' (p<.001) were associated with undergoing CDA. Higher area level unemployment was associated with ACDF.

CONCLUSION

Wide spread racial, gender-related, and socioeconomic disparities have been observed. Identification of these disparities is sentinel for implication of change in health-care policy mitigating issues such as underinsurance leading to establishment of health equity.