Association of Race, Health Insurance Status, and Household Income With Location and Outcomes of Ambulatory Surgery Among Adult Patients in 2 US States

Abstract

The receipt of surgery in freestanding ambulatory surgery centers (ASCs) is often less costly compared with surgery in hospital-based outpatient departments. Although increasing numbers of surgical procedures are now being performed in freestanding ASCs, questions remain regarding the existence of disparities among patients receiving care at ASCs. OBJECTIVE To examine the association of patient race, health insurance status, and household income with the location (ASC vs hospital-based outpatient department) of ambulatory surgery. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the State Ambulatory Surgery and Services Databases of the Healthcare Cost and Utilization Project to perform a secondary analysis of patients who received ambulatory surgery in New York and Florida between 2011 and 2013. Patients aged 18 to 89 years who underwent 12 different types of ambulatory surgical procedures were included. Data were analyzed from December 2018 to June 2019. MAIN OUTCOMES AND MEASURESReceipt of surgery at a freestanding ASC and 30-day unplanned hospital visits after ambulatory surgery. RESULTS A total of 5.6 million patients in New York (57.4% female; 68.9% aged Ն50 years; and 62.5% White) and 7.5 million patients in Florida (57.3% female; 77.4% aged Ն50 years; 74.3% White) who received ambulatory surgery were included in the analysis. After adjusting for age, comorbidities, health insurance status, household income, location of surgery, and type of surgical procedure, the likelihood of receiving ambulatory surgery at a freestanding ASC was significantly lower among Black patients (adjusted odds ratio [aOR], 0.82; 95% CI, 0.81-0.83; P < .001) and Hispanic patients (aOR, 0.78; 95% CI, 0.77-0.79; P < .001) compared with White patients in New York. This likelihood was also lower among Black patients (aOR, 0.65; 95% CI, 0.65-0.66; P < .001) compared with White patients in Florida. Public health insurance coverage was associated with a significantly lower likelihood of receiving ambulatory surgery at freestanding ASCs in both New York and Florida, particularly among patients with Medicaid

Social Disparities in Outpatient and Inpatient Management of Pediatric Supracondylar Humerus Fractures

“…While there are no previous studies on the socioeconomic patient characteristic differences between inpatient or outpatient care for pediatric SCHF patients, recent studies on total hip and total knee arthroplasties have emphasized that higher SDI scores are associated with inpatient care, alongside African American race, and existence of comorbidities [ 16 , 24 ]. More specifically, a recent study of adult ambulatory surgical care in New York also reported that Black and Hispanic patients had higher odds of receiving inpatient care [ 25 ]. Thus, although this is the first study to explore such disparities in the pediatric orthopaedic population, these trends are likely not unique to pediatric SCHFs and provide insight into the impacts of disparate care with respect to surgical setting.…”

Race-Based Differences in the Utilization and Timing of Secondary Cleft Procedures in the United States

“…Overall, findings of underutilization among patients who are Black are not surprising, as they are consistent with other studies of racial disparity in non-cleft populations, which have shown substantial under-utilization of non-emergent surgery among Black populations in the United States (Tompson et al, 2019). This has been attributed, among other factors, to socioeconomic disparity and poorer insurance coverage (Sohn, 2017, Janeway et al, 2020), fewer positive experiences with healthcare as described within social networks (Mota et al, 2012), less explanation of medical options by the operating surgeons (Hausmann et al, 2011), and a general distrust of the medical profession due to historical discrimination (Gamble, 1993). Any combination of these factors may have contributed to underutilization observed in this study, although further study is needed to recognize barriers specific to the Black cleft population.…”

Trends in Geographic Disparities in Access to Ambulatory Surgery Centers in New York, 2010 to 2018

“…We focused the analysis on patients who underwent ambulatory arthroscopy, cataract excision, cystoscopy, cholecystectomy, or endoscopy in 2010 to 2018, using Current Procedural Terminology codes that were previously described (eMethods 1 in the Supplement). [2][3][4] Facilities were designated as ASCs or hospital outpatient departments (HOPDs) using data obtained from the SPARCS website.A previously validated socioeconomic advantage score (SES) 5 was calculated at the county and zip code−level using data from the American Community Survey (2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018). This summary score comprised 6 variables that measured wealth, education, and occupation (eMethods 2 in the Supplement).…”