- •Unplanned surgery is more common among minoritized Medicare beneficiaries.
- •Mortality and readmissions increase for Asian & Black patients after unplanned surgery.
- •Reducing rates of unplanned surgery may mitigate overall surgical disparities.
While significant efforts have been made to understand surgical disparities for procedures that are performed in either the elective or unplanned settings, far less is known about procedures performed in both settings.
Cross-sectional study of 1,135,743 Medicare beneficiaries undergoing incisional hernia repair, colectomy, or abdominal aortic aneurysm repair between 2014 and 2018. Risk-adjusted outcomes were assessed using multivariable logistic regression.
Compared to White beneficiaries, unplanned surgery rates were higher for Black (44.0%vs38.8%, OR = 1.29,p < 0.001) and Asian beneficiaries(40.4%vs38.8%,OR = 1.09,p < 0.001). While there were minimal differences in 30-day mortality for elective procedures, unplanned procedures demonstrated wider disparities (Black vs White 12.4%vs11.3%,OR = 1.11,p < 0.001; Asian vs White 13.2%vs11.3%,OR = 1.18,p < 0.001). Similar patterns were observed for readmissions.
Unplanned procedures are more common and demonstrate wider disparities in outcomes among minority Medicare beneficiaries. Reducing unplanned surgery rates among these groups may be an effective strategy to limit overall disparities in postoperative outcomes.
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- Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors.J Am Coll Surg. 2013; 216 (e412): 482-492
- Racial disparities in surgical mortality: the gap appears to have narrowed.Health Aff. 2017; 36: 1057-1064
- Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery.Surgery. 2018; 163: 832-838
- Racial disparities in abdominal aortic aneurysm repair among male Medicare beneficiaries.Arch Surg. 2008; 143: 506-510
- Inpatient outcomes after elective versus nonelective ventral hernia repair.J Surg Res. 2015; 198: 305-310
- Disparities in access to trauma care in the United States: a population-based analysis.Injury. 2017; 48: 332-338
- State-by-state variation in emergency versus elective colon resections: room for improvement.J Trauma Acute Care Surg. 2013; 74: 1286-1291
- Racial disparities in 30-day readmission rates after elective spine surgery: a single institutional experience.Spine (Phila. 2016; 41 (Pa 1976)): 1677-1682
- AAA repair: sociodemographic disparities in management and outcomes.Vasc Endovasc Surg. 2008; 42: 555-560
- Racial disparities in readmissions for patients with inflammatory bowel disease (IBD) after colorectal surgery.J Gastrointest Surg. 2016; 20: 985-993
- Racial and ethnic disparities in the treatment of unruptured thoracoabdominal aortic aneurysms in the United States.J Surg Res. 2013; 184: 651-657
- Worse outcomes among uninsured general surgery patients: does the need for an emergency operation explain these disparities?.Surgery. 2014; 156: 345-351
- Impact of race and socioeconomic status on presentation and management of ventral hernias.Arch Surg. 2010; 145: 776-780
- 2nd. Racial, ethnic, and socioeconomic disparities in patient outcomes after craniotomy for tumor in adult patients in the United States, 1988-2004.Neurosurgery. 2010; 66 (discussion 437-428): 427-437
- Reduced disparities and improved surgical outcomes for Asian Americans with colorectal cancer.J Surg Res. 2017; 218: 23-28
- Impact of race/ethnicity on prognosis in patients who underwent surgery for colon cancer: analysis for white, African, and East Asian Americans.Ann Surg Oncol. 2012; 19: 1517-1528
- Overall survival is impacted by birthplace and not extent of surgery in Asian Americans with resectable gastric cancer.J Gastrointest Surg. 2015; 19: 1966-1973
- Disparities in gastric cancer outcomes among Asian ethnicities in the USA.Ann Surg Oncol. 2009; 16: 2433-2441
- Ethnic disparities in breast cancer management among Asian Americans and Pacific Islanders.Ann Surg Oncol. 2006; 13: 977-984
- Asian Americans and prostate cancer: a nationwide population-based analysis.Urol Oncol: Seminars and Original Investigations. 2016; 34 (233.e237-233.e215)
- Temporal trends of incidence and mortality in Asian-Americans with pancreatic adenocarcinoma: an epidemiological study.Ann Gastroenterol. 2020; 33: 210-218
- Patient, hospital, and neighborhood factors associated with treatment of early-stage breast cancer among Asian American women in California.Cancer Epidemiol Biomarkers Prev. 2012; 21: 821-834
- Assessing quality using administrative data.Ann Intern Med. 1997; 127: 666-674
- Identifying complications of care using administrative data.Med Care. 1994; 32: 700-715
- Identification of in-hospital complications from claims data. Is it valid?.Med Care. 2000; 38: 785-795
- Use of administrative data to find substandard care: validation of the complications screening program.Med Care. 2000; 38: 796-806
Published online: August 28, 2022
Accepted: August 24, 2022
Received in revised form: August 19, 2022
Received: February 10, 2022
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