Association of County-Level Racial Diversity and Likelihood of a Textbook Outcome Following Pancreas Surgery

Abstract

Introduction Residential racial desegregation has demonstrated improved economic and education outcomes. The degree of racial community segregation relative to surgical outcomes has not been examined. Patients and Methods Patients undergoing pancreatic resection between 2013 and 2017 were identified from Medicare Standard Analytic Files. A diversity index for each county was calculated from the American Community Survey. Multivariable mixed-effects logistic regression with a random effect for hospital was used to measure the association of the diversity index level with textbook outcome (TO). Results Among the 24,298 Medicare beneficiaries who underwent a pancreatic resection, most patients were male ( n = 12,784, 52.6%), White ( n = 21,616, 89%), and had a median age of 72 (68–77) years. The overall incidence of TO following pancreatic surgery was 43.3%. On multivariable analysis, patients who resided in low-diversity areas had 16% lower odds of experiencing a TO following pancreatic resection compared with patients from high-diversity communities (OR 0.84, 95% CI 0.72–0.98). Compared with patients who resided in the high-diversity areas, individuals who lived in low-diversity areas had higher odds of 90-day readmission (OR 1.16, 95% CI 1.03–1.31) and had higher odds of dying within 90 days (OR 1.85, 95% CI 1.45–2.38) (both p < 0.05). Nonminority patients who resided in low-diversity areas also had a 14% decreased likelihood to achieve a TO after pancreatic resection compared with nonminority patients in high-diversity areas (OR 0.86, 95% CI 0.73–1.00). Conclusion Patients residing in the lowest racial/ethnic integrated counties were considerably less likely to have an optimal TO following pancreatic resection compared with patients who resided in the highest racially integrated counties. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-10316-3.

Association of Insurance Type With Colorectal Surgery Outcomes and Costs at a Safety-Net Hospital

“…We chose TO as our primary outcome because composite measures often provide more comprehensive assessments of surgical outcomes than single variables. 40 – 42 Our data demonstrate the utility of this approach. While all component variables had increased aOR for Medicare and Medicaid/Uninsured patients compared to the Private insurance group (Table 3 ), only CDIV complications were significant for Medicare and 30-day EDOS and readmissions for Medicaid/Uninsured patients.…”

Persistent poverty impacts access to minimally invasive surgery among patients with hepatopancreatobiliary cancer

“…PP is associated with worse postoperative course following surgical resection. 29 Our research group has recently reported on the association of county‐level poverty duration relative to individual‐level cancer outcomes 10 . Duration of poverty was associated with lower odds of receipt of surgical treatment, achievement of textbook outcomes, and worse cancer‐specific survival.…”

Textbook outcome in hepato-pancreato-biliary surgery: systematic review

“…A high SVI was an independent predictor of complications and 90-day deaths after both pancreatic and liver surgery as well as prolonged LOS in liver surgery 17 . Socioeconomic factors independently associated with achievement of TO were lower patient education, government insurance, low county-level racial diversity, and Black race 6 , 18 , 24 , 27 .…”