Title : Delayed surgery among patients diagnosed with spinal disorders: Retrospective analysis

Untreated spinal cord conditions can lead to more severe symptoms, poor health outcomes, and decreased quality of life. Health disparities in the diagnosis and treatment of these conditions add complexity to this debilitating problem.

To determine the association between race and access to healthcare services with respect to the treatment of spinal cord disorders, we performed a retrospective cohort study of patients receiving an initial diagnosis at two major hospitals in Boston from September 1, 2017, to June 1, 2018, with follow-up through December 31, 2019. Data from patients (18-89 years of age) diagnosed with spinal cord disorders were extracted retrospectively from a centralized database. Kaplan-Meier curves and multivariable Cox proportional hazards models analyzed the time to spine surgery following initial diagnosis.

Patient race was the primary explanatory variable, with five racial groups (Asian, Black, Hispanic, Other, and White) based on a combination of their self-reported race and ethnicity.

We defined race by the following categories: Hispanic ethnicity (regardless of race), non-Hispanic ethnicity (designated Asian, Black, or White), and “Other” (non-Hispanic patients who designated their race as other than Asian, Black, or White; this included American Indian, Alaska Native, Native Hawaiian or other Pacific Islander, or two or more races). Among 56,186 patients (4% Asian, 7% Black, 5% Hispanic, 6% Other, 77% White) meeting inclusion criteria, Asian (hazard ratio (HR) 0.67 (0.55, 0.82)), Black (HR 0.55 (0.47, 0.63)), Hispanic (HR 0.43 (0.35, 0.52)), and Other (HR 0.59 (0.51, 0.69)) patients had significantly longer times to surgery compared with White patients.

Keywords: spinal cord disorders, diagnosis of spinal cord disorder, racial dipartites, time to diagnosis, time to surgery 

Dr. Linda S. Aglio MD MS is an Associate Professor, Harvard Medical School and the Founding Director of Neuroanesthesia as well as the Founding Director of Intraoperative Neurophysiologic Monitoring at the Brigham and Women's Hospital in Boston, MA, USA.

She is a neuroanesthesiologist  and pain researcher whose work has focused on defining how perioperative neuroscience can be translated into safer, more efficient, and more equitable neurosurgical care. Her academic career has been shaped by excellence in clinical care, innovation in perioperative neurosurgical management, and national leadership in education. Central to her work is the translation of neuroanesthesia and perioperative evidence into clinical practice, with measurable improvements in patient outcomes, safety, and efficiency in the care of complex neurosurgical populations.