Meta-analysis of operative mortality and complications in patients from minority ethnic groups

Bloo, Gerrit; Hesselink, Gijs; Oron, Assaf P.; Emond, E. J. J. M.; Damen, Johan; Dekkers, W.J.M.; Westert, Gert P.; Wolff, André; Calsbeek, Hiske; Wollersheim, Hub

doi:10.1002/bjs.9609

Cited by 10 publications

(13 citation statements)

References 56 publications

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“…For other surgical specialties, the negative influence of being of a minority race on outcomes is largely reported in current literature. [1][2][3] Plastic surgeons counsel their patients accordingly, and this may be a factor contributing to the discrepancies in numbers of breast reconstructive procedures among different racial patient groups. Whether a patient is deemed fit for the breast reconstruction is undoubtedly influenced by a complex interaction of factors, Butler et al identified one of the reasons to be "reluctance by some plastic surgeons to provide reconstruction presumably out of concern for preexisting comorbidities and suboptimal health status."…”

Section: Discussionmentioning

confidence: 99%

“…to be related to social and economic disparities, 4 the differences in outcomes are still not fully understood. 1,5 Lucas et al described this phenomena in many different surgical interventions, including coronary artery bypass, abdominal aortic aneurysm repair, radical cystectomy, esophagectomy, and pancreatic resection. 6 However, very little is known with regard to racial disparities in the outcomes of breast reconstructive surgery.…”

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confidence: 99%

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Racial Disparities in Outcomes of Reconstructive Breast Surgery: An Analysis of 51,362 Patients from the ACS-NSQIP

Blankensteijn

Sparenberg

Crystal

et al. 2020

J Reconstr Microsurg

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Background In various surgical specialties, racial disparities in postoperative complications are widely reported. It is assumed that the effect of race can also be found in plastic surgical outcomes, although this remains largely undefined in literature. This study aims to provide data on the impact of race on outcomes of reconstructive breast surgery. Methods Data were collected using the NSQIP (National Surgical Quality Improvement Program) database (2008–2016). Outcomes of the reconstructive breast surgery of White patients were compared with those of African American, Asian, or other races. Logistic regression was performed to control for variations between all groups. Analysis of racial disparities was further sub-stratified according to four different types of breast reconstruction: delayed or immediate autologous, and delayed or immediate prosthesis-based reconstruction. Results In total, this study included 51,362 patients of which 43,864 were Caucasian, 5,135 African American, 2,057 Asian, and 332 of other races. When compared with White patients, patients of African American race had larger body mass indices (31.3 ± 7.0 vs. 27.6 ± 6.3, p-value < 0.001) in addition to higher rates of diabetes (12.3 vs 4.6%, p-value < 0.001) and hypertension (44.7 vs. 23.4%, p-value < 0.001). Both multivariate analysis and the sub-stratified analysis of different types of reconstruction showed no differences in overall complication rate. Conclusion Among the four types of reconstructive procedures, differences in surgical outcomes do not appear to be based on race and therefore seem to be less evident in reconstructive breast surgery compared with the current literature within other surgical specialties.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Racial Disparities in Outcomes of Reconstructive Breast Surgery: An Analysis of 51,362 Patients from the ACS-NSQIP

Blankensteijn

Sparenberg

Crystal

et al. 2020

J Reconstr Microsurg

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“…Baehr et al and Okoroh et al in their systematic reviews also noted increased risk of certain ADEs among certain ethnicities for some drugs and contributed these to genetic predisposition and overuse [35,59]. Five systematic reviews concerning adverse events in surgical patients and ADEs were also included [35,37,56,58,59]. In their systematic review and meta-analyses of 26 studies relating to complications and mortality in surgical care, Bloo et al found that ethnic minorities have a higher risk of complications in perioperative care as compared to the ethnic majority patients resulting in a higher incidence of pain and re-operation [37].…”

Section: Review Q 2: What Is the Evidence For Patient Safety Events Imentioning

confidence: 99%

“…Five systematic reviews concerning adverse events in surgical patients and ADEs were also included [35,37,56,58,59]. In their systematic review and meta-analyses of 26 studies relating to complications and mortality in surgical care, Bloo et al found that ethnic minorities have a higher risk of complications in perioperative care as compared to the ethnic majority patients resulting in a higher incidence of pain and re-operation [37]. Some included studies in their review discussed the causative factors of the differences in the outcome and ranged from sociocultural, biological and presurgical risk factors but noted that these were mostly speculative highlighting the need for further analyses of the factors at patient, physician and system level [37].…”

Section: Review Q 2: What Is the Evidence For Patient Safety Events Imentioning

confidence: 99%

The safety of health care for ethnic minority patients: a systematic review

Chauhan

Walton

Manias

et al. 2020

Int J Equity Health

142

157

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Introduction: Evidence to date indicates that patients from ethnic minority backgrounds may experience disparity in the quality and safety of health care they receive due to a range of socio-cultural factors. Although heightened risk of patient safety events is of key concern, there is a dearth of evidence regarding the nature and rate of patient safety events occurring amongst ethnic minority consumers, which is critical for the development of relevant intervention approaches to enhance the safety of their care. Objectives: To establish how ethnic minority populations are conceptualised in the international literature, and the implications of this in shaping of our findings; the evidence of patient safety events arising among ethnic minority healthcare consumers internationally; and the individual, service and system factors that contribute to unsafe care. Method: A systematic review of five databases (MEDLINE, PUBMED, PsycINFO, EMBASE and CINAHL) were undertaken using subject headings (MeSH) and keywords to identify studies relevant to our objectives. Inclusion criteria were applied independently by two researchers. A narrative synthesis was undertaken due to heterogeneity of the study designs of included studies followed by a study appraisal process. Results: Forty-five studies were included in this review. Findings indicate that: (1) those from ethnic minority backgrounds were conceptualised variably; (2) people from ethnic minority backgrounds had higher rates of hospital acquired infections, complications, adverse drug events and dosing errors when compared to the wider population; and (3) factors including language proficiency, beliefs about illness and treatment, formal and informal interpreter use, consumer engagement, and interactions with health professionals contributed to increased risk of safety events amongst these populations. Conclusion: Ethnic minority consumers may experience inequity in the safety of care and be at higher risk of patient safety events. Health services and systems must consider the individual, inter-and intra-ethnic variations in the nature of safety events to understand the where and how to invest resource to enhance equity in the safety of care. Review registration: This systematic review is registered with Research Registry: reviewregistry761.

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“…In a previous study conducted in Pakistan, prevalence of myopia, hypermetropia and astigmatism was 36.5%, 27.1%, and 37%, respectively 18 . Cataract is the largest cause of blindness worldwide 19,20 . The number of people blind from cataract in the world is increasing by approximately 1 million per year and the number of 'operable' cataract eyes with a visual acuity of less than 6/60 is increasing by 4-5 million per year.…”

Section: Resultsmentioning

confidence: 99%

Screening for Eye Diseases & Refractive Errors in District Jail Inmates, Lahore

Javed¹,

Hussain²,

Khan³

2020

pak J Ophthalmol

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Background: Refractive errors and eye diseases are the main core issues in the jail inmates in Pakistan and especially in Punjab province but with best efforts the ophthalmic disorders can be controlled with the help of better screening process for refractive errors, presbyopia, low vision and the general ophthalmic disorders that are found among the jail inmates. The over burden of these ailments can be minimized following a comprehensive screening methods time to time using slandered guidelines approved by WHO. Methodology: A plan was executed for basic necessary screening process to find out the ophthalmic diseases and vision problems. A team of ophthalmologist, optometrists and ophthalmic technicians visited inmates in the jail who presented with any eye problem in this 1-day screening. Auto refraction and manual retinoscopy was done. Visual cut off point was 6/12. Ophthalmic eye medication and glasses (spectacles) was provided free of cost. Results: a total of 270 inmates were examined in the eye camp. The study showed prevalence of refractive errors 4% with a significant high ratio of presbyopia 34% as 79%of inmates were more than 40 year of age. Prevalence of other main eye disease was: conjunctivitis 3%, glaucoma 1% and cataract 2%. Conclusions: There is an urgent need to look into matter of presence the eye diseases and refractive errors found among jail inmates as they fall in the category of marginalized community and the health care provided with ease has no provision the general eye health care. So it is an important issue to lodge a comprehensive effective initiative for the provision of that need mentioned above and a training program for the medical staff of jail hospitals to screen out this community for effective screening knowledge in Primary Eye care.

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Meta-analysis of operative mortality and complications in patients from minority ethnic groups

Abstract: Patients from minority ethnic groups, in North America and elsewhere, have an increased risk of perioperative death and complications. More insight is needed into the causes of ethnic disparities to pursue safer perioperative care for patients of minority ethnicity.

Cited by 10 publications

References 56 publications

Racial Disparities in Outcomes of Reconstructive Breast Surgery: An Analysis of 51,362 Patients from the ACS-NSQIP

Racial Disparities in Outcomes of Reconstructive Breast Surgery: An Analysis of 51,362 Patients from the ACS-NSQIP

The safety of health care for ethnic minority patients: a systematic review

Screening for Eye Diseases & Refractive Errors in District Jail Inmates, Lahore

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