Racial/Ethnic Associations with Morbidity and Mortality in Adults with Acute Traumatic Cervical Spinal Cord Injury

Aladine A Elsamadicy; Selma Belkasim; Paul Serrato; Sina Sadeghzadeh; Shaila D Ghanekar; Syed I Khalid; Sheng-Fu Larry Lo; Daniel M Sciubba

doi:10.1097/BRS.0000000000005260

Racial/Ethnic Associations with Morbidity and Mortality in Adults with Acute Traumatic Cervical Spinal Cord Injury

Spine (Phila Pa 1976). 2025 Jan 21. doi: 10.1097/BRS.0000000000005260. Online ahead of print.

Authors

Aladine A Elsamadicy¹, Selma Belkasim¹, Paul Serrato¹, Sina Sadeghzadeh², Shaila D Ghanekar¹, Syed I Khalid³, Sheng-Fu Larry Lo⁴, Daniel M Sciubba⁴

Affiliations

¹ Department of Neurosurgery, Yale University School of Medicine, New Haven, CT.
² Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA.
³ Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL.
⁴ Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY.

PMID: 39835366
DOI: 10.1097/BRS.0000000000005260

Abstract

Study design: Retrospective cohort study.

Objective: This study aimed to investigate the association of race with morbidity and mortality in acute cervical spinal cord injury (cSCI) patients.

Summary of background data: Racial disparities in spine surgery are associated with adverse outcomes, however, the impact of race on cSCI is understudied.

Methods: We retrospectively reviewed the American College of Surgeons Trauma Quality Programs database to compare outcomes for acute cSCI patients between racial/ethnic identities: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic/Latino (HIS), and other (OTH). Demographics, comorbidities, injury type, treatment modality, and adverse events (AEs) were assessed. Multivariable logistic regression was used to identify independent predictors of AEs, non-routine discharge (NRD), and in-hospital mortality.

Results: There were 71,048 patients stratified by race/ethnicity: 44,639 (62.8%) NHW, 13,555 (19.1%) NHB, 5,820 (8.2%) HIS, and 7,034 (9.9%) OTH. NHB and HIS-identifying patients had the greatest rates of any AE (NHW: 20.7% vs. NHB: 25.0% vs. HIS: 24.6% vs. OTH: 22.0%, P<0.001) and the longest mean length of stay (NHW: 11.3±13.5 d vs. NHB: 15.5±20.2 d vs. HIS: 15.0±20.5 d vs. OTH: 12.6±17.5 d, P<0.001). NRDs were lowest for HIS-identifying patients (NHW: 74.8% vs. NHB: 75.5% vs. HIS: 69.5% vs. OTH: 75.4%, P<0.001), while in-hospital mortality was lowest for NHB-identifying patients (NHW: 12.8% vs. NHB: 10.1% vs. HIS: 12.4% vs. OTH: 13.4%, P<0.001). On multivariable analyses, NHB (OR: 1.16, P<0.001), HIS (OR: 1.22, P<0.001), and OTH (OR: 1.14, P=0.004) cohorts had significantly increased odds of AEs. The NHB cohort had significantly increased odds (OR: 1.25, P<0.001), while the HIS cohort had significantly decreased odds (OR: 0.78, P=0.001) of NRD. Only the NHB cohort had significantly decreased odds of in-hospital mortality (OR: 0.69, P<0.001).

Conclusion: Our study suggests racial disparities in outcomes and discharge disposition for acute cSCI patients.