Provider’s Exposure to Diversity Contributes to Socioeconomic Disparities in Lumbar and Cervical Fusion Outcomes

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=29200-44400), 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.