Access to common laparoscopic general surgical procedures: do racial disparities exist?

Wood, Kasey Leigh; Haider, Syed; Bui, Anthony; Leitman, I. Michael

doi:10.1007/s00464-019-06912-w

Cited by 34 publications

(17 citation statements)

References 65 publications

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“…In particular, there was a paucity of studies conducted in surgical, obstetric, and pediatric settings. While this may be partly explained by pre-existing disparities in access to and quality of care in these settings [63][64][65][66], it will be important to study PRO implementation across the entirety of the healthcare spectrum with particular attention to those presently unrepresented in research to date.…”

Section: Discussionmentioning

confidence: 99%

Implementing patient-reported outcomes in routine clinical care for diverse and underrepresented patients in the United States

Hyland

Guo

Dhawan

et al. 2022

J Patient Rep Outcomes

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Background Patient-reported outcomes (PROs) are used increasingly in routine clinical care and inform policies, reimbursements, and quality improvement. Less is known regarding PRO implementation in routine clinical care for diverse and underrepresented patient populations. Objective This review aims to identify studies of PRO implementation in diverse and underrepresented patient populations, elucidate representation of clinical specialties, assess implementation outcomes, and synthesize patient needs, concerns, and preferences. Methods MEDLINE, Embase, Web of Science, CINAHL, and PsycINFO were searched September 2021 for studies aiming to study PRO implementation in diverse and underrepresented patient populations within the United States. Studies were screened and data extracted by three independent reviewers. Implementation outcomes were assessed according to Proctor et al. taxonomy. A descriptive analysis of data was conducted. Results The search yielded 8,687 records, and 28 studies met inclusion criteria. The majority were observational cohort studies (n = 21, 75%) and conducted in primary care (n = 10, 36%). Most studies included majority female (n = 19, 68%) and non-White populations (n = 15, 54%), while fewer reported socioeconomic (n = 11, 39%) or insurance status (n = 9, 32.1%). Most studies assessed implementation outcomes of feasibility (n = 27, 96%) and acceptability (n = 19, 68%); costs (n = 3, 11%), penetration (n = 1, 4%), and sustainability (n = 1, 4%) were infrequently assessed. Conclusion PRO implementation in routine clinical care for diverse and underrepresented patient populations is generally feasible and acceptable. Research is lacking in key clinical specialties. Further work is needed to understand how health disparities drive PRO implementation outcomes.

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Section: Discussionmentioning

confidence: 99%

Implementing patient-reported outcomes in routine clinical care for diverse and underrepresented patients in the United States

Hyland

Guo

Dhawan

et al. 2022

J Patient Rep Outcomes

View full text Add to dashboard Cite

show abstract

“…It is widely accepted that minimally invasive approaches in common general surgery operations are associated with less morbidity, and racial inequality in accessing minimally invasive surgery has been previously observed. 24 Such inequalities certainly contribute to known racial disparities in surgical outcomes, and it is important to understand the mechanisms that contribute to differences in application of MIG. [25][26][27][28] Geographic biases in minimally invasive surgery have been previously shown and is thought to reflect regional training patterns.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Utilization and Outcomes of Minimally Invasive Techniques for Gastric Cancer Surgery in the United States

et al. 2022

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Background This study investigated national implementation patterns and perioperative outcomes of minimally invasive gastrectomy (MIG) in gastric cancer surgery in the United States. Methods The National Inpatient Sample (NIS) was queried for patients who underwent elective gastrectomy for gastric cancer from 2008-2018. The MIG versus open gastrectomy approach was correlated with hospital factors, patient characteristics, and complications. Results There was more than a fivefold increase in MIG from 5.8% in 2008 to 32.9% in 2018 (nptrend < 0.001). Patients undergoing MIG had a lower Elixhauser Comorbidity Index (p = 0.001). On risk adjusted analysis, black patients (AOR = 0.77, p = 0.024) and patients with income below 25th percentile (AOR = 0.80, p = 0.018) were less likely to undergo MIG. When these analyses were limited to minimally invasive capable centers only, these differences were not observed. Hospitals in the upper tertile of gastrectomy case volume, Northeast, and urban teaching centers were more likely to perform MIG. Overall, MIG was associated with a 0.7-day decrease in length of stay, reduced risk adjusted mortality rates (AOR = 0.58, p = 0.05), and a $4,700 increase in total cost. Conclusions In this national retrospective study, we observe socioeconomic differences in patients undergoing MIG, which is explained by hospital level factors in MIG utilization. We demonstrate that MIG is associated with a lower mortality compared with open gastrectomy. Establishing MIG as a safe approach to gastric cancers and understanding regional differences in implementation patterns can inform delivery of equitable high-quality health care.

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“…African American patients are less likely to be considered for laparoscopic approaches for routine abdominal surgeries, and African American children are at increased risk for postoperative mortality, morbidity, and hospital resource utilization. 17,18 However, no studies have specifically examined the association between race and time until operation for urgent and emergent surgeries. Bowman et al noted that African American patients were more likely to require emergent ventral hernia surgery and experienced higher 30-day readmission rates than white patients.…”

Section: Discussionmentioning

confidence: 99%

Systemic Determinants in Surgery: Nonclinical Factors Affecting Time to Operation for Incarcerated Ventral Hernias

Wang

Barrera

Coppa

et al. 2021

The American Surgeon

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Introduction We explore nonclinical factors affecting the amount of time from admission to the operating room for patients requiring nonelective repair of ventral hernias. Methods Using the 2005-2012 Nationwide Inpatient Sample, we identified adult patients with a primary diagnosis of ventral hernia without obstruction/gangrene, who underwent nonelective repair. The outcome variable of interest was time from admission to surgery. We performed univariate and multivariable analyses using negative binomial regression, adjusting for age, sex, race, income, insurance, admission day, comorbidity status (van Walraven score), diagnosis, procedure, hospital size, location/teaching status, and region. Results 7,253 patients met criteria, of which majority were women (n = 4,615) and white (n = 5,394). The majority of patients had private insurance (n = 3,015) followed by Medicare (n = 2,737). Median time to operation was 0 days. Univariate analysis comparing operation <1 day to ≥1 day identified significant differences in race, day of admission, insurance, length of stay, comorbidity status, hospital location, type, and size. Negative binomial regression showed that weekday admission (IRR 4.42, P < .0001), private insurance (IRR 1.53-2.66, P < .0001), rural location (IRR 1.39-1.76, P < .01), small hospital size (IRR 1.26-1.36, P < .05), white race (IRR 1.30-1.34, P < .01), healthier patients (van Walraven score IRR 1.05, P < .0001), and use of mesh (IRR 0.39-0.56, P < .02) were associated with shorter time until procedure. Conclusion Shorter time from admission to the operating room was associated with several nonclinical factors, which suggest disparities may exist. Further prospective studies are warranted to elucidate these disparities affecting patient care.

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Access to common laparoscopic general surgical procedures: do racial disparities exist?

Cited by 34 publications

References 65 publications

Implementing patient-reported outcomes in routine clinical care for diverse and underrepresented patients in the United States

Implementing patient-reported outcomes in routine clinical care for diverse and underrepresented patients in the United States

Disparities in Utilization and Outcomes of Minimally Invasive Techniques for Gastric Cancer Surgery in the United States

Systemic Determinants in Surgery: Nonclinical Factors Affecting Time to Operation for Incarcerated Ventral Hernias

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