Elsevier

World Neurosurgery

Volume 96, December 2016, Pages 107-110
World Neurosurgery

Original Article
Race as an Independent Predictor of Temporal Delay in Time to Diagnosis and Treatment in Patients with Cervical Stenosis: A Study of 133 Patients with Anterior Cervical Discectomy and Fusion

https://doi.org/10.1016/j.wneu.2016.08.070Get rights and content

Background

Prompt decompression in clinically significant cervical stenosis is important in the prevention of neurological sequelae. Disparities exist along the continuum on spine care, with black patients receiving less surgery and experiencing worse postoperative outcomes. The aim of this study was to assess whether black race was an independent predictor for a prolonged time to diagnosis and treatment.

Methods

The medical records of 133 patients undergoing elective anterior cervical discectomy and fusion surgery at a major academic medical center between 2010 and 2012 were reviewed. All patients had prospectively collected patient-reported outcomes measures including visual analogue scale (VAS) of pain. Data on patient demographics, comorbidities, and postoperative complication rates were retrospectively collected. Multivariate analysis was performed on variables that trended with delay in diagnosis and treatment on univariate analysis to determine independent predictors of delay in diagnosis and treatment.

Results

Patient demographics of the cohort included 45.87% male, 80.30% white, 71.97% married, 53.72% employed, 18.8% with a history of depression, and 19.55% with anxiety. The mean ± standard deviation age was 54.02 ± 11.74 years and baseline VAS-neck pain was 4.87 ± 3.19. In a multivariate analysis, race was the only statistically significant variable (P = 0.0212) to predict increased duration of preoperative pain before treatment. Other variables in the model included depression, anxiety, age, gender, employment status, marital status, body mass index, and baseline VAS-neck pain score.

Conclusions

Our study demonstrates that race is an independent risk factor for a temporal delay in diagnosis and treatment of symptomatic cervical stenosis.

Introduction

Biopsychosocial factors play a significant role in the diagnosis, management, and treatment of medical conditions. Delays in medical treatments are associated with worse prognosis and an increase in associated medical cost.1, 2, 3 In the treatment of spinal cord compression, it is advantageous to decompress the spine in a timely manner to have optimal probability of returning to maximal function.4, 5 As the number of elective spinal surgeries being performed is increasing and in an effort to reduce healthcare disparities, it is essential to understand the independent factors that are associated with increased delays to diagnosis and treatment of cervical spine stenosis.

Prior studies have examined other factors that influence surgical decisions for treatment of spinal pathologies. In a retrospective review of 555 patients undergoing elective spine surgery for the treatment of degenerative lumbar stenosis Kim et al6 determined that motor weakness, male sex, morphologic stenotic grade, and amount of disability are independent variables associated in surgical decision making. The role of independent factors associated with delay in diagnosis and treatment for elective spine surgery has been relatively understudied.

The aim of this study is to investigate the independent predictors for a temporal delay in time to diagnosis and treatment of cervical stenosis in elective anterior cervical discectomy and fusion (ACDF) spine surgery.

Section snippets

Methods

This was a retrospective analysis of a prospectively collected database. The medical records were retrospectively reviewed of 133 adult patients undergoing elective ACDF spine surgery at a major academic medical center between 2010 and 2012. Institutional Review Board approval was obtained before the study's initiation. Duration of preoperative pain was assessed by recording the number of months the patient has been experiencing the neck pain at the initial clinic visit. All patients had

Results

All 133 adult patients were included in this study. The mean ± SD age and BMI for the cohort was 54.02 ± 11.74 years and 28.91 ± 7.13 kg/m2, respectively (Table 1). The cohort included 45.87% men and most were white patients (80.3%; Table 1). There were similar prevalences of anxiety (19.55%) and depression (18.80%; Table 1). Of the cohort 71.97% were married and 53.72% had an active employment status (Table 1). The prevalence of comorbidities in the cohort consisted of: 12.03% having diabetes,

Discussion

In this retrospective cohort study assessing the independent predictors of a temporal delay in time to diagnosis and treatment for cervical stenosis in patients undergoing an elective ACDF procedure, we demonstrate that race is an independent predictor in delay to diagnosis and treatment.

Previous studies have shown that race is associated with delays in diagnosis and treatment. In a recent study assessing independent predictors of the delay from diagnosis to endarterectomy in the treatment of

Conclusion

Our study demonstrates that black race is an independent risk factor for a temporal delay in diagnosis and treatment of symptomatic cervical stenosis. Whereas the reasons for the observed delay are not entirely clear, awareness of this disparity may help surgeons avoid undesirable delays in operating on black patients.

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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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