Disparities in Surgical Access: A Systematic Literature Review, Conceptual Model, and Evidence Map

Jager, Elzerie de; Levine, Alexander; Udyavar, N. Rhea; Burstin, Helen; Bhulani, Nizar; Hoyt, David B.; Ko, Clifford Y.; Weissman, Joel S.; Britt, L. D.; Haider, Adil H.; Maggard-Gibbons, Melinda

doi:10.1016/j.jamcollsurg.2018.12.028

Cited by 122 publications

(111 citation statements)

References 237 publications

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“…A framework for understanding healthcare disparities can be conceptually understood through three distinct measures: (1) indication detection, (2) progression to surgery, and (3) receipt of optimal care. 10 Using this model, the rate of cochlear implantation qualification can be considered a surrogate for candidacy referral since a notably high cochlear implantation qualification rate is potentially indicative that referral for evaluation is occurring at a more advanced stage of hearing loss (ie, delayed referral). In other words, if everyone who is screened for a cochlear implant qualifies, there is a high likelihood that patients who are borderline cochlear implant candidates are not being referred for evaluation.…”

Section: Discussionmentioning

confidence: 99%

Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program

Tolisano

Schauwecker

Baumgart

et al. 2019

Ann Otol Rhinol Laryngol

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Objective: To identify demographic predictors of patients undergoing cochlear implantation evaluation and surgery. Methods: Consecutive adult patients between 2009 and 2018 who underwent cochlear implantation evaluation at a university cochlear implantation program were retrospectively identified to determine (1) cochlear implantation qualification rate and (2) pursuit of surgery rate with respect to age, gender, race, primary spoken language, marital status, insurance type, and distance to the cochlear implantation center. Results: A total of 823 cochlear implantation evaluations were analyzed. Overall, 76.3% of patients qualified for cochlear implantation and 61.5% of these patients pursued surgery. Age was the only independent predictor for cochlear implantation qualification, such that, for each year younger, the odds of qualifying for cochlear implantation increased by 2.5% (OR 0.98; 95% CI: 0.96-0.99). Age, race, marital status, and insurance type were each independent predictors of the decision to pursue surgery. The odds of pursuing surgery increased by 2.8% for each year younger (OR 1.03; 95% CI: 1.01-1.05). Compared to White patients, non-Whites were half as likely to pursue surgery (OR 0.47; 95% CI: 0.25-0.88). Single (OR 0.49; 95% CI: 0.26-0.94) and widowed patients (OR 0.46; 95% CI: 0.23-0.95) were about half as likely to pursue surgery as compared to married patients. Patients with military insurance were 13 times more likely to pursue surgery as compared to patients with Medicare (OR 13.0; 95% CI: 1.67-101.4). Conclusion: Younger age is an independent predictor for a higher cochlear implantation qualification rate, suggesting the possibility for delayed candidacy referral. Rate of surgical pursuit in qualified cochlear implantation candidates is lower for racial minorities, single and widowed patients, and older patients.

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Section: Discussionmentioning

confidence: 99%

Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program

Tolisano

Schauwecker

Baumgart

et al. 2019

Ann Otol Rhinol Laryngol

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“…Epidemiological data report higher obesity rates in African Americans and Hispanics compared with white, non-Hispanics in the United States [1]. Given similarities in socio-economic factors between AAs and Hispanics, and the racial disparities that exist in access to health care, education, and/or insurance [31], it would be of great interest to utilize the MBSAQIP to examine potential similarities and/or differences in underlying comorbidities and perioperative outcomes…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Bariatric Surgery in African Americans: an Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Data Registry

et al. 2020

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Background The incidence of obesity is disproportionally high in African Americans (AA) in the United States. This study compared outcomes for AA patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) with non-AA patients. Methods The MBSAQIP database was reviewed for RYGB and SG patients (2015-2017). Patients were identified as AA or non-AA and grouped to RYGB or SG. Combined and univariate analyses were performed on unmatched/propensity matched populations to assess outcomes. Results After applying exclusion criteria, 75,409 AA and 354,305 non-AA patients remained. Univariate analysis identified AA-RYGB and AA-SG patients were heavier and younger than non-AA patients. Overall, AA patients tended to have fewer preoperative comorbidities than non-AA patients with the majority of AA comorbidities related to hypertension and renal disease. Analysis of propensity matched data confirmed AA bariatric surgery patients had increased cardiovascular-related disease incidence compared with non-AA patients. Perioperatively, AA-RYGB patients had longer operative times, increased rates of major complications/ICU admission, and increased incidence of 30-day readmission, re-intervention, and reoperation, concomitant with lower rates of minor complications/superficial surgical site infection (SSI) compared with non-AA patients. For SG, AA patients had longer operative times and higher rates of major complications and 30-day readmission, re-intervention, and mortality, coupled with fewer minor complications, superficial/organ space SSI, and leak. Conclusion African American patients undergoing bariatric surgery are younger and heavier than non-AA patients and present with different comorbidity profiles. Overall, AAs exhibit worse outcomes following RYGB or SG than non-AA patients, including increased mortality rates in AA-SG patients.

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“…We also found that children from households with a primary language other than English experience disparity in surgery care. Access barriers related to language, insurance status, and lack of a usual source of health care can add to the disparity faced by minority children 22 ; thus, the adjusted odds ratio for Hispanic children which was higher relative to unadjusted rates may underestimate the true extent of the disparity experienced by this population 18 . Although prior studies found differences by income, when adjusting for other salient socioeconomic factors related to healthcare access, such as insurance status and language, income was not an independent predictor of the rate of pediatric surgery.…”

Section: Discussionmentioning

confidence: 99%

“…While these data cannot differentiate whether disparities occurred in critical vs. noncritical surgeries or whether these disparities yielded poorer outcomes, prior studies demonstrate disparities in rates as well as outcomes of a range of critical surgery procedures, from emergent procedures such as appendectomy to specialized procedures such as craniosynostosis repair, spinal fusion, and neuro‐oncologic surgeries 1‐3,6,16,17 . De Jager et al developed a conceptual model of disparities in surgical access, highlighting four levels of access barriers: provider access, detection of a surgical indication, progression to surgery, and receipt of optimal care 18 . While the majority of research has been conducted in adults, studies detecting disparities in pediatric surgical conditions were identified at each of these levels.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Pediatric Surgery in the United States

Rabbitts

Groenewald

2020

Pediatric Anesthesia

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Background: The epidemiology of pediatric surgery in the United States and whether disparities in access to surgical care exist on a national level remain inadequately described. Aims: We determined rates of surgical intervention and associations with sociodemographic factors among children 0-17 years of age in the United States. Methods: Analysis of the 2005-2018 National Health Interview Survey samples included 155,064 children. Parents reported on whether their child had a surgery or surgical procedure either as an inpatient or outpatient over the past 12 months. Multivariate logistic regression models, adjusted for age, sex, race and ethnicity, income, language, parent education, region, having a usual source of care, and comorbid conditions, examined odds ratios for sociodemographic factors associated with surgery, analyzing the most recent data (2016-2018; 25 544 children). Results: In the most recent data, 4.7% of children had surgical intervention each year, with an average of 3.9 million surgeries performed annually. Rates of surgery were stable between 2005 and 2018. Minority children had lower adjusted odds (aOR) of surgical intervention as compared to white, non-Hispanic children (aOR = 0.6, 95%CI = 0.5-0.8 for black children, and aOR = 0.7, 95%CI = 0.5-0.9 for Hispanic children). Other sociodemographic factors associated with a lower adjusted odd of surgical intervention included uninsured status (aOR = 0.5; 95%CI = 0.3-0.9), and primary language other than English (aOR = 0.5; 95%CI 0.3-0.9). Income was not associated with surgical intervention. Conclusions: On average, 3.9 million surgeries are performed on children 0-17 years of age in the United States each year. Significant disparities exist in surgical care for children, with black and Hispanic children having lower rates of surgery over and above contribution of other disparity domains. These findings in a nationally representative sample highlight the need for national policies to eliminate disparity of care received by minority children.

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Disparities in Surgical Access: A Systematic Literature Review, Conceptual Model, and Evidence Map

Cited by 122 publications

References 237 publications

Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program

Identifying Disadvantaged Groups for Cochlear Implantation: Demographics from a Large Cochlear Implant Program

Outcomes of Bariatric Surgery in African Americans: an Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Data Registry

Epidemiology of Pediatric Surgery in the United States

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