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Examining disparities among older multimorbid emergency general surgery patients: An observational study of Medicare beneficiaries

Published:November 20, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.11.026

      Highlights

      • No differences in 30-day mortality between Black and White multimorbid patients.
      • Black multimorbid patients had significantly lower odds of complications.
      • Risk-adjusted Medicare EGS patients do not experience significant health disparities.
      • Use of the QCS framework allows for more effective risk adjustment.

      Abstract

      Background

      Qualifying comorbidity sets (QCS) are tools used to identify multimorbid patients at increased surgical risk. It is unknown how the QCS framework for multimorbidity affects surgical risk in different racial groups.

      Methods

      This retrospective cohort study included Medicare patients age ≥65.5 who underwent an emergency general surgery operation from 2015-2018. Our exposure was race and multimorbidity, included in our model as an interaction term. The primary outcome of the study was 30-day mortality. Secondary outcomes included routine discharge, 30-day readmission, length of stay, and complications.

      Results

      In total, 163,148 patients who underwent and operation were included in this study. Of these, 13,852 (8.5%, p < 0.001) were Black, and 149,296 (91.5%, p < 0.001) were White. Black multimorbid patients had no significant differences in 30-day mortality, routine discharge or 30-day readmission when compared to White multimorbid patients after risk-adjustment. Black multimorbid patients had significantly lower odds of complications (OR 0.89, p = 0.014) compared to White multimorbid patients.

      Conclusions

      Our study of universally insured patients highlights the critical role of pre-operative health status and its association with surgical outcomes.

      Keywords

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