Lumbar Fusion and Decompression in American Indian, Alaskan Native, Native Hawaiian, and Pacific Islander Populations: Healthcare Disparities in Spine Surgery

Abstract

Introduction: Racial disparities in surgical outcomes are well documented, yet data on American Indian/Alaskan Native (AI/AN) and Native Hawaiian/Pacific Islander (NH/PI) populations remain limited. This study examines disparities in 30-day outcomes following lumbar decompression and fusion in these underrepresented groups.

Materials and methods: A retrospective analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program database (2017-2020). Patients undergoing lumbar decompression and fusion were identified via current procedural terminology codes. Multivariable logistic regression models adjusted for demographic and clinical factors assessed associations between race/ethnicity and postoperative outcomes, including readmission, complications, reoperation, and non-home discharge. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported.

Results: Among 113,340 patients, 0.38% (n=429) were AI/AN patients and 0.20% (n=229) were NH/PI patients. Compared to non-Hispanic White patients, AI/AN patients had higher odds of readmission (AOR: 1.023, 95% CI: 1.003-1.043, p=0.026) and complications (AOR: 1.030, 95% CI: 1.004-1.056, p=0.023). NH/PI patients had increased odds of readmission (AOR: 1.033, 95% CI: 1.006-1.062, p=0.018), major complications (AOR: 1.029, 95% CI: 1.007-1.051, p=0.009), and reoperation (AOR: 1.035, 95% CI: 1.014-1.057, p=0.001).

Conclusions: AI/AN and NH/PI patients face higher risks of adverse postoperative outcomes following lumbar spine surgery. Targeted interventions and increased inclusion in surgical disparities research are needed to improve equity in spine care.