Racial Disparities in Surgical Outcomes Persist in Emergency General Surgery
Abstract
Objective: Racial disparities in surgical outcomes are well-documented in elective specialties. Less is understood about disparities in emergency general surgery (EGS). We aimed to determine the association of race/ethnicity... [ view full abstract ]
Objective: Racial disparities in surgical outcomes are well-documented in elective specialties. Less is understood about disparities in emergency general surgery (EGS). We aimed to determine the association of race/ethnicity to readmission rates, lengths of stay (LOS), and mortality after EGS. Methods: We queried the 2011-2014 ACS-NSQIP database for patients undergoing EGS and stratified by race/ethnicity. Univariate/multivariate analyses were used to examined readmission rate, LOS and 30-day mortality. Results: Of 114,411 patients undergoing EGS, 69.6% were white, 13.3% Hispanic, 12.1% black and 4.9% Asian. Compared to other ethnic groups, black patients had higher rates of heart failure, end-stage renal disease on dialysis, total functional dependence, hypertension, smoking, diabetes, presentation with open or infected wound, and ASA Class 4-5 (p<0.001). Black patients had the highest readmission rates (9.3%) and mean LOS (7.54 days) compared to the other groups (p<0.001). White patients had the highest 30-day mortality rate (6.5%) compared to other groups (p<0.001). On adjusted comparison, black race was not independently associated with higher readmission rates (OR 1.01 95%CI 0.95-1.08); however, Hispanic (OR=0.88 95%CI 0.81-0.95) and Asian (OR=0.78 95%CI 0.69-0.88) race was associated with lower risk for readmission. Black race remained independently associated with longer LOS by 6-14% compared to other races (p<0.0001). Compared to white patients, other races had a lower risk of mortality (p<0.0001).
Conclusion: Black patients undergoing EGS had significantly longer LOS than other races. Mortality was highest for white patients. Further studies are needed to better understand these observations and to identify actionable opportunities to reduce these disparities.
Authors
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Adam Lucy
(University of Alabama at Birmingham)
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Matthew Giglia
(University Of Alabama At Birmingham, Department Of Surgery)
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Lauren Wood
(University of Alabama at Birmingham)
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Jeffrey Kerby
(University of Alabama at Birmingham)
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Patrick Bosarge
(University of Alabama at Birmingham)
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Daniel I. Chu
(University Of Alabama At Birmingham, Department Of Surgery, Division of Gastrointestinal Surgery)
Topic Areas
General Surgery , Trauma / Critical Care
Session
QS-TCC/CT » Quick-Shot Presentations: Trauma/Critical Care/Acute Care Surgery/Cardiothoracic Surgery (15:00 - Thursday, 21st September, Dearth Tower Conf 2)