I am from Hawaii — I guess they call us Pacific Islanders for purposes of tracking race/ethnicity. I’m going to travel to California to have a cervical fusion done. Many people from the islands go there for major medical care. Do you think I need to find someone who specializes in surgery on Hawaiians (or should I say Pacific Islanders?).

The United States Census keeps track of different racial groups such as Native Americans, Hispanics, and Asian or Pacific Islanders. States like California that have a hospital database also collect information on patient demographics. Besides race, they also record gender (male versus female), age, place of residence, your weight, and the procedure you are having done. In addition, the records also contain how many days patients were in the hospital and the total costs.

Data like this makes it possible to study a large number of people for a variety of different reasons. For example, in a recent study from California, researchers looked at the effect of morbid obesity on complications and complication rates associated with spinal fusion.

Obesity is defined by a body mass index (BMI) of 30 or greater. Morbid obesity is determined by a BMI of 40 or more. The BMI is a measure of body fat based on height. It isn’t the only way to identify obesity but it is a quick and easy method to get a general idea of relative sizes.

They looked at four groups of patients based on location of the fusion (cervical or lumbar) and type of surgical approach (anterior or posterior). As part of the study, they also collected data on race including four groups: white, black, Asian or Pacific Islander, and Native American.

Analysis of the data did not show a statistically significant effect of race on results. They found that morbid obesity was, in fact, the single most significant predictor of postoperative complications. The rate of complications among the morbidly obese was 97 per cent higher than among patients of normal weight.

That high rate was consistent for all types of postoperative problems (e.g., heart attacks, blood clots, pneumonia, infections). Fortunately, the death rate was not higher in those who were morbidly obese. Overall costs were increased by 28 per cent. Older age combined with morbid obesity resulted in even higher complication rates.

Race as a biologic patient characteristic is typically not as much of a risk factor that requires a specialist to treat you. The most common underlying factor is really how you live, what your lifestyle choices are, and your willingness/motivation to make healthy choices. Surgeons must watch out for patients who smoke, who are overweight, or who are not likely to follow their instructions. Any of these choices can lead to higher postoperative problems and complications.