Racial Disparities in Outcomes Following Transforaminal and Interlaminar Endoscopic Lumbar Spine Discectomy: A Single Institutional Analysis

Introduction: Racial disparities in care are often unearthed when studying trends in subspecialized medicine, specifically in neurosurgery. Growing evidence suggests poorer outcomes for African American patients undergoing surgery. However, the extent of disparity in endoscopic lumbar spine discectomy (ELSD) outcomes is unclear. This study aims to assess racial disparities in surgical outcomes between African American and Asian American vs White patients in undergoing ELSD.

Methods: A single institutional endoscopic spine surgery database was queried to identify patients undergoing interlaminar or transforaminal ELSD. Postoperative outcomes including bleeding complications, persistent numbness or tingling, radiculitis, return to operative room, and readmission were assessed. Chi-squared and ANOVA tests were used to compare baseline clinical characteristics and postoperative outcomes between races.

Results: A total of 147 patients were included in our analysis (50.7% female, mean age 54.85 ± 16.43 years). Average hospital LOS was 2±4.5 days, average LOS after surgery was 0.5±1 days, and mean operative time was 81.7±28.1 minutes. Of the patients, 12 (8.2%) were Asian American, 27 (18.5%) were African American, and 107 (73.3%) were White. On ANOVA test, there was no statistically significant difference in age, hospital LOS, LOS after surgery, or operative time between the racial groups. On Chi-squared test, African American patients had a higher risk of returning to OR compared to White and Asian American (18.5% vs 5.7% and 0%). There was no significant difference in other postoperative complications between the racial groups.

Conclusion : African American patients undergoing interlaminar or transforaminal ELSD exhibit a higher risk of returning to OR compared to Asian American and White patients. Large multicenter prospective studies are merited to further investigate the racial disparities in outcomes after ELSD surgeries.