Racial/Ethnic Disparities in Perioperative Outcomes of Major Procedures

Ravi, Praful; Sood, Akshay; Schmid, Marianne; Abdollah, Firas; Sammon, Jesse D.; Sun, Maxine; Klett, Dane; Varda, Briony K.; Peabody, James O.; Menon, Mani; Kibel, Adam S.; Nguyen, Paul L.; Trinh, Quoc Dien

doi:10.1097/sla.0000000000001078

Cited by 107 publications

(48 citation statements)

References 42 publications

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“…1 This relationship extends to the surgical domain where black patients were demonstrated to have a prolonged length of hospital stay in 10 of the 16 major procedures studied. 2 This study, however, failed to demonstrate a disparity in overall complication rates in cases of major urologic cancer surgery-radical cystectomy, radical prostatectomy, and nephrectomy. Previous publications have also been unable to define the contribution of differences in individual patient-level characteristics to any identified disparity between the race groups because these studies have generally used multivariable logistic regression analyses.…”

Section: Introductionmentioning

confidence: 71%

“…Previous publications have also been unable to define the contribution of differences in individual patient-level characteristics to any identified disparity between the race groups because these studies have generally used multivariable logistic regression analyses. 2,3 Important biological differences in disease between black and white patients that impact complications also need to be factored in. Population-based data suggest that the incidence of prostate cancer and the rate of progression to distant disease is higher among black men.…”

Section: Introductionmentioning

confidence: 99%

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Racial Disparities in Surgical Outcomes Among Males Following Major Urologic Cancer Surgery

Sathianathen

Jarosek

Fan

et al. 2018

American Journal of Preventive Medicine

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Introduction: Disparities in healthcare outcomes between races have been extensively described; however, studies fail to characterize the contribution of differences in distribution of covariates between groups and the impact of discrimination. This study aims to characterize the degree to which clinicodemographic factors and unmeasured confounders are contributing to any observed disparities between non-Hispanic white and black males on surgical outcomes after major urologic cancer surgery. Methods: Non-Hispanic white and black males undergoing radical cystectomy, nephrectomy, or prostatectomy for cancer in the American College of Surgeons National Surgical Quality Improvement Program database from 2007 to 2016 were included in this analysis. The outcome of interest was Clavien IIIÀV complications. Analysis was conducted in 2017 using the PetersÀBelson method to compare the disparity in outcomes while adjusting for 13 important demographic and clinical characteristics. Results: Of the 15,693 cases included with complete data, 13.0% (n=2,040) were black. There was a significantly increased rate of unadjusted Clavien III and V complications between white versus black males for radical cystectomy (21.9% vs 10.1%, p=0.005); nephrectomy (6.4% vs 3.9%, p=0.028); and radical prostatectomy (2.3% vs 1.6%, p=0.046). Adjusting for differences in age, BMI, American Society of Anesthesiologists score, functional status, smoking history, and comorbidities including diabetes, chronic obstructive pulmonary disease, heart failure, renal failure, bleeding disorder, steroid use, unintentional weight loss, and hypertension between the groups could not explain the disparity in complications after radical cystectomy; the unexplained discrepancy was an absolute excess of 11.8% (p=0.01) in black males. There was an unexplained excess of complications in black males undergoing radical prostatectomy and nephrectomy but neither reached statistical significance. Conclusions: Black males undergoing radical cystectomy for cancer experienced higher complication rates than white males. Unexplained differences between the black and white males significantly contributed to the disparity in outcomes, which suggests that unmeasured factors, such as the quality of surgical or perioperative care, are playing a considerable role in the observed inequality.

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Section: Introductionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Racial Disparities in Surgical Outcomes Among Males Following Major Urologic Cancer Surgery

Sathianathen

Jarosek

Fan

et al. 2018

American Journal of Preventive Medicine

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“…Barriers in culture, language, and medical literacy may all play a role in this disparity in access, which is consistent with prior literature indicating racial differences in peri-operative outcomes. 23 Insurance provider also significantly influenced likelihood of receiving Delayed-CCY, as patients with Medicaid-insurance and no insurance were significantly less likely to have Delayed-CCY compared to patients with private insurance. Our data are consistent with prior literature suggesting uninsured and Medicaid patients undergo emergent repair of ventral hernias at a significantly higher rate than patients with private insurance, who typically undergo elective hernia repair.…”

Section: Discussionmentioning

confidence: 99%

Practice Patterns for Cholecystectomy After Endoscopic Retrograde Cholangiopancreatography for Patients With Choledocholithiasis

et al. 2017

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Background & Aims Cholecystectomy (CCY) following an episode of choledocholithiasis requiring endoscopic retrograde cholangio-pancreatography (ERCP) with stone extraction reduces recurrent biliary events, compared to expectant management. We studied practice patterns for performance of CCY following ERCP for choledocholithiasis using data from 3 large states and evaluated the effects of delaying CCY. Methods We conducted a retrospective cohort study using the ambulatory surgery, inpatient, and emergency department databases from the states of California (years 2009–2011), New York (2011–2013), and Florida (2012–2014). We collected data from 4516 patients hospitalized with choledocholithiasis who underwent ERCP. We compared outcomes of patients who underwent CCY at index admission (early CCY), elective CCY within 60 days of discharge (delayed CCY), or did not undergo CCY (no CCY), calculating rate of recurrent biliary events (defined as an emergency department visit or unplanned hospitalization due to symptomatic cholelithiasis, cholecystitis, choledocholithiasis, cholangitis, or biliary pancreatitis), mortality, and cost by CCY cohort. We also evaluated risk factors for not undergoing CCY. The primary outcome measure was the rate of recurrent biliary events in the 365 days following discharge from index admission. Results Of the patients who underwent ERCP for choledocholithiasis, 41.2% underwent early CCY, 10.9% underwent delayed CCY, and 48.0% underwent no CCY. Early CCY reduced relative risk of recurrent biliary events within 60 days by 92%, compared with delayed or no CCY (P<.001). After 60 days following discharge from index admission, patients with early CCY had an 87% lower risk of recurrent biliary events than patients with no CCY (P<.001) and patients with delayed CCY had an 88% lower risk of recurrent biliary events than patients with no CCY (P<.001). A strategy of delayed CCY performed on an outpatient basis was least costly. Performance of early CCY was inversely associated with low facility volume. Hispanic race, Asian race, Medicaid insurance, and no insurance associated inversely with performance of delayed CCY. Conclusions In a retrospective analysis of over 4500 patients hospitalized with choledocholithiasis, we found that CCY was not performed following ERCP for almost half of the cases. Although early and delayed CCY equally reduce the risk of subsequent recurrent biliary events, patients are at 10-fold higher risk of recurrent biliary event while waiting for a delayed CCY compared with patients who underwent early CCY. Delayed CCY is a cost-effective strategy that must be balanced against the risk of loss to follow up, particularly among patients who are ethnic minorities or have little or no health insurance.

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“…Holding other covariates and outcome variables in the model constant, non-Hispanic White participants are expected to have 26% more days spent in the hospital as compared to non-Hispanic minority participants. Although health disparities research has identified racial differences in cancer treatment recommendations (Li, Malone, & Daling, 2003; Shavers & Brown, 2002) and choices (Hurwitz et al, 2016; Ross et al, 2016), research examining hospital length of stay has found non-White cancer patients have longer stays as compared to their White counterparts (Parsons, Habermann, Stain, Vickers, & Al-Refaie, 2012; Ravi et al, 2015). A potential explanation for our conflicting finding may be due to the heterogeneity of the cancer diagnoses of participants in this study.…”

Section: Discussionmentioning

confidence: 99%

Health Literacy Is an Independent Predictor of Cancer Patients' Hospitalizations

Cartwright¹,

Dumenci²,

Cassel³

et al. 2017

HLRP: Health Literacy Research and Practice

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Background: Lower levels of health literacy predict higher hospitalization rates. Hospitalization is expensive and many admissions are potentially avoidable. Research examining the relationship between health literacy and health outcomes for cancer patients is limited, and no published studies to date have focused on hospitalization and health literacy in cancer patients. Objective: This study examined the ability of health literacy to predict hospitalization of cancer patients. Methods: This secondary data analysis investigated the relationship between health literacy and hospitalization rates of adult cancer patients in the first 5 years after their diagnosis. The sample included a diverse selection of cancer diagnoses and all stages of cancer were represented. Health literacy was assessed using the Cancer Health Literacy Test 30 (CHLT-30), a psychometrically sound measure of health literacy validated in a cancer patient population. Health literacy's ability to predict the number of times hospitalized, total days spent hospitalized, and number of 30-day readmissions was examined using multivariate negative binomial multiple regression to control for the outcomes and potentially confounding variables. Key Results: When controlling for potentially confounding variables, a negative relationship was found between health literacy and the number of inpatient hospitalizations (β = −0.041, p = .009) and the total number of days spent hospitalized (β = −0.028, p = .023) independently, whereas the relationship between health literacy and the number of 30-day readmissions failed to reach significance (β = −0.002, p = .903). Conclusions: Patients with lower health literacy need additional assistance to avoid unplanned hospitalizations. [ Health Literacy Research and Practice . 2017;1(4):e153–e162.] Plain Language Summary: Results from this study found that as cancer patients' health literacy scores decreased, the number of times hospitalized and the total number of days spent in the hospital increased. This relationship was significant when controlling for diagnosis, stage at diagnosis, receipt of chemotherapy, number of comorbidities, death, education, and race. Cancer patients with low health literacy are at a higher risk of being hospitalized.

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Racial/Ethnic Disparities in Perioperative Outcomes of Major Procedures

Cited by 107 publications

References 42 publications

Racial Disparities in Surgical Outcomes Among Males Following Major Urologic Cancer Surgery

Racial Disparities in Surgical Outcomes Among Males Following Major Urologic Cancer Surgery

Practice Patterns for Cholecystectomy After Endoscopic Retrograde Cholangiopancreatography for Patients With Choledocholithiasis

Health Literacy Is an Independent Predictor of Cancer Patients' Hospitalizations

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