Outcomes Following Surgical Management of Cauda Equina Syndrome: Does Race Matter?

  • Amit Jain
  • Emmanuel Menga
  • Addisu Mesfin


Cauda equina syndrome (CES) is a surgical emergency requiring urgent spinal decompression. Our objective is to analyze the association between race and in-hospital outcomes (complications, mortality, length of stay, and discharge disposition) in patients with CES. This is a retrospective cohort study of CES patients identified via the Nationwide Inpatient Sample (NIS) from 2000 to 2010 in inpatient hospitalizations in the USA. The patient sample includes 46,017 patients ≥18 undergoing spine surgery for CES. Using ICD9-CM codes, patient records with a diagnosis of CES from 2003 to 2010 were selected from the NIS database and sorted by mortality, complications, length of hospital stay, and discharge status. Demographic information (age, gender, race, and insurance status) and hospital characteristics were evaluated. African-American patients were 1.38-fold (p < 0.02; 95% odds ratio [OR] 1.05–1.83) more likely than Caucasian patients to develop complications based on a multivariate logistic regression model adjusted for patient age, insurance status, surgical approach, and hospital size. There was no difference in mortality among patients of various races in both univariate and multivariate analysis. A multivariate linear regression model adjusted for insurance status, surgical approach, and hospital size revealed that, compared to Caucasian patients, length of hospitalization in African-American patients was 1.92 days longer (p < 0.01), 1.34 days longer (p < 0.01) in Hispanic patients, and 2.24 days longer (p < 0.01) in Asian-American patients. African-American patients were 0.59-fold (p < 0.01; 95% OR 0.494–0.708) less likely than Caucasian patients to have routine discharge to home. African-American patients hospitalized for surgical management of CES experience significantly more complications, longer length of hospitalizations, and higher discharge to non-home locations, compared to Caucasian patients.


Cauda equina syndrome Race Disparities Complication Nationwide inpatient sample 


Compliance with Ethical Standards

Conflict of Interest

Dr. Jain declares he has no conflict of interest. Dr. Menga declares he has no conflict of interest. Dr. Mesfin has received research funding from Globus.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© W. Montague Cobb-NMA Health Institute 2017

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryJohns Hopkins UniversityBaltimoreUSA
  2. 2.Department of Orthopaedic SurgeryUniversity of Texas San AntonioSan AntonioUSA
  3. 3.Department of Orthopaedic SurgeryUniversity of RochesterRochesterUSA
  4. 4.School of Medicine and DentistryUniversity of RochesterRochesterUSA

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