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. 2025 Mar 29;17(3):e81409.
doi: 10.7759/cureus.81409. eCollection 2025 Mar.

Lumbar Fusion and Decompression in American Indian, Alaskan Native, Native Hawaiian, and Pacific Islander Populations: Healthcare Disparities in Spine Surgery

Mohammad F Khan  1 , Saarang Patel  2 , Dillon H Putzler  3 , Avi N Albert  4 , Hibbah I Khan  1 , Ryan T Gensler  5 , Maveric Abella  3 , Jeffrey Hayashi  3 , Frishan O Paulo  3 , Julian L Gendreau  6 , Janette Bow-Keola  3 , Andrea Finlay  7 , Derek F Amanatullah  7 , Thomas Noh  3
Affiliations

Lumbar Fusion and Decompression in American Indian, Alaskan Native, Native Hawaiian, and Pacific Islander Populations: Healthcare Disparities in Spine Surgery

Mohammad F Khan et al. Cureus. .

Abstract

Introduction: Racial disparities in surgical outcomes are well documented, yet data on American Indian/Alaskan Native (AI/AN) and Native Hawaiian/Pacific Islander (NH/PI) populations remain limited. This study examines disparities in 30-day outcomes following lumbar decompression and fusion in these underrepresented groups.

Materials and methods: A retrospective analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program database (2017-2020). Patients undergoing lumbar decompression and fusion were identified via current procedural terminology codes. Multivariable logistic regression models adjusted for demographic and clinical factors assessed associations between race/ethnicity and postoperative outcomes, including readmission, complications, reoperation, and non-home discharge. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported.

Results: Among 113,340 patients, 0.38% (n=429) were AI/AN patients and 0.20% (n=229) were NH/PI patients. Compared to non-Hispanic White patients, AI/AN patients had higher odds of readmission (AOR: 1.023, 95% CI: 1.003-1.043, p=0.026) and complications (AOR: 1.030, 95% CI: 1.004-1.056, p=0.023). NH/PI patients had increased odds of readmission (AOR: 1.033, 95% CI: 1.006-1.062, p=0.018), major complications (AOR: 1.029, 95% CI: 1.007-1.051, p=0.009), and reoperation (AOR: 1.035, 95% CI: 1.014-1.057, p=0.001).

Conclusions: AI/AN and NH/PI patients face higher risks of adverse postoperative outcomes following lumbar spine surgery. Targeted interventions and increased inclusion in surgical disparities research are needed to improve equity in spine care.

Keywords: american indian/alaskan native (ai/an); lumbar spine surgery; native hawaiian/pacific islander (nh/pi); postoperative outcomes; racial disparities; surgical equity.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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