Racial Disparities in Surgical Outcomes Following Colorectal Surgery for Diverticulitis

Objective: To determine if race is a predictor of surgical outcomes in mortality, post-operative complications (POCs), and length of stay (LOS) following colorectal surgery for diverticulitis. Methods: The American College of... [ view full abstract ]

Objective: To determine if race is a predictor of surgical outcomes in mortality, post-operative complications (POCs), and length of stay (LOS) following colorectal surgery for diverticulitis.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) for 2011-2015 was queried for all patients who underwent colectomy surgery for diverticulitis and stratified by race/ethnicity. Univariate and multivariate analyses examined 30-day mortality, POCs, and LOS.

Results: Of 20,318 patients who underwent surgery for diverticulitis, 91.5% were Caucasian-American, 7.4% African-American, and 1.1% Asian-American. Asian-Americans were more likely than other racial/ethnic groups to be normal weight (36.6%, p<0.001), not smoke (86.9%, p<0.001), have lower ASA score of 1-2 (57.5%, p<0.001), and have shorter operation-time (150 min, p<0.001). There were no differences in 30-day mortality, but African-American patients had the longest LOS. Compared to other racial/ethnic groups, Asian-American had lower rates of ileus (11.8%, p<0.001), respiratory (4.5%, p=0.03) and sepsis complications (8.6%, p<0.001). African-Americans had higher 30-day readmissions rates (11.2%, p=0.007), ileus complications (11.8%, p<0.001), sepsis complications (13.1%, p<0.001), and bleeding complications (12%, p<0.001). On multivariate analyses, African-American race remained independently associated with more post-operative ileus (OR=1.85, p<0.001), sepsis (OR=1.63, p<0.001), respiratory (OR=1.50, p=0.0004), and bleeding complications (OR=2.17, p<0.001). African-Americans remained independently associated with an 8% increase in LOS as compared to Caucasian-American patients (IRR 1.08, p<0.001).

Conclusion: African-Americans undergoing surgery for diverticulitis have higher readmission rates and higher POCs such as ileus, sepsis, and respiratory complications when compared to other racial/ethnic groups. Further studies are needed to understand these racial disparities.