You might be referring to a recent study conducted by the staff at the Department of Neurosurgery, Cedars-Sinai Medical Center in Los Angeles, California. They wanted to assess national trends in the surgical treatment of idiopathic scoliosis, so they used information from the Nationwide Inpatient Sample or NIS to compare the number and types of patients who had spinal fusion surgery for idiopathic scoliosis.
The NIS is a computer database with information collected on all patients who enter a hospital. Patient demographics (e.g., age, sex, race, income, insurance information, education) and hospital characteristics (e.g., size, bed capacity, teaching versus nonteaching) can be evaluated. They also analyzed information from the NIS on postoperative complications.
According to this study, there were some socioeconomic and racial trends suggestive of health care disparities. For example, if you have idiopathic scoliosis, you are more likely to be treated surgically if you are 1) white, 2) have private insurance, and 3) have access to a large hospital.
Whites (or Caucasians) had the highest rate of surgery for idiopathic scoliosis. Patients with private insurance were two times more likely to have spinal fusion surgery for this condition. Non-Caucasians (African Americans, Hispanics, Asian/Pacific Islanders, Native Americans) were much more likely to have complications after surgery.
Hispanic patients had the highest rate of complications. In all age groups and for all races and income levels, pulmonary (lung) problems were the most common followed by hematoma (bleeding). African Americans were more likely to suffer cardiac complications. Their death rate was also the highest. This finding was attributed to “less frequent use of effective cardiac medications” and “poorer overall quality of care” for this group.
There are some limitations of this study because all the information wasn’t always collected and entered on each patient. The lack of complete data entry can be considered a weakness of the system and possibly misrepresent the true outcomes studied. Data collected in the NIS do not reflect the severity of each person’s scoliosis, the presence of other spinal problems, or the reasons why surgery was done.
But the authors still concluded that surgical treatment of idiopathic scoliosis follows a similar trend observed with other medical problems: health care disparities do exist based on race and ethnicity and they can be significant.
Bringing these patterns to the awareness of policy makers may help solve this complex problem. There may be cultural reasons for some of the differences that must also be addressed. For example, minority patients are less likely to accept recommended services or treatment and less likely to follow through with treatment suggestions.
Future studies using the National Inpatient Sample (NIS) will need better control over missing data, especially if the information is related to important data about patient income, race, and age. A closer look at the high rate of complications (causes and risk factors) might be helpful in preventing or reducing postoperative problems.
Before cancelling any plans you may have in place, talk with your child’s neurosurgeon. Ask him or her to review with you the potential problems your child might experience and perhaps the likelihood that any of these could develop. Death during or after any surgery is a very serious thing and deserves attention so that all concerned are comfortable and confident in any decisions made that affect the plan of care.