Provider's exposure to diversity contributes to socioeconomic disparities in lumbar and cervical fusion outcomes

Gavin Touponse; Karen Malacon; Guan Li; Ezra Yoseph; Summer Han; Corinna Zygourakis

doi:10.1016/j.wnsx.2024.100382

Provider's exposure to diversity contributes to socioeconomic disparities in lumbar and cervical fusion outcomes

World Neurosurg X. 2024 Apr 25:23:100382. doi: 10.1016/j.wnsx.2024.100382. eCollection 2024 Jul.

Authors

Gavin Touponse¹, Karen Malacon¹, Guan Li¹, Ezra Yoseph¹, Summer Han^{1

2}, Corinna Zygourakis¹

Affiliations

¹ Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
² Quantative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.

Abstract

Background: Studies report patient race, income, and education influence spinal fusion outcomes; fewer studies, however, examine the influence of provider factors such as exposure to diversity or cultural sensitivity.

Objective: To examine how providers' experience with diverse patient populations affects spinal fusion outcomes.

Methods: Retrospective review of 39,680 patients undergoing lumbar and cervical fusions, 2003-2021, in Clinformatics® Data Mart national database. We used the provider patient racial diversity index (pRDI)-a published metric of physician exposure to diverse patients-to divide patients into groups based their provider's category (I, II, III) where patients treated by category III providers had surgeons with the most diverse patient populations. Multivariate regression models on propensity score-matched cohorts examined the association between patient SES and provider category on post-operative outcomes.

Results: Black patients had decreased discharge home (OR 0.67; 95% CI 0.54-0.83) compared to white patients. Patients treated by category III providers had increased length of stay (Coeff. 0.62; 95% CI 0.43-0.81), charge (Coeff. 36800; 95% CI 29,200-44,400), and decreased discharge home (OR 0.90; 95% CI 0.83-0.97) compared to patients treated by category I providers. Asian patients treated by category II providers had decreased readmission (OR 0.38; 95% CI 0.14-0.96), and Black patients treated by category III providers had increased discharge home (OR 1.41; 95% CI 1.1-1.9) compared to those treated by category I providers.

Conclusion: While our study found two specific instances of improved spine surgery outcomes for minority patients treated by providers serving diverse patient populations, we present mixed findings overall. This study serves as the foundation for future research to better understand how provider pRDI affects outcomes in patients undergoing lumbar and cervical spine surgery.

Keywords: Healthcare disparities; Provider patient racial diversity index; Race; Socioeconomic status; Spinal fusion; Spine outcomes; Spine surgery.