Racial Disparities in Readmissions for Patients with Inflammatory Bowel Disease (IBD) After Colorectal Surgery

Gunnells, Drew J.; Morris, Melanie S.; DeRussy, Aerin J.; Gullick, Allison A.; Malik, Talha A.; Cannon, Jamie A.; Hawn, Mary T.; Chu, Daniel I.

doi:10.1007/s11605-015-3068-9

Cited by 37 publications

(16 citation statements)

References 38 publications

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“…Even after multivariable analysis, rates of extended HLOS were between 15% and 20% higher for African‐Americans and ‘Others’. These data are indirectly supported by previous studies such as that of Gunnells et al , who showed that African‐American patients with IBD have higher rates of 30‐day readmission after elective surgery, and Montgomery et al , who reported that African‐American patients with IBD undergoing surgery had significantly higher complication rates even after multivariable analysis.…”

Section: Discussionsupporting

confidence: 79%

Racial disparities after stoma construction in colorectal surgery

et al. 2020

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Aim Racial disparities are under‐recognized among patients undergoing colorectal surgery. The purpose of this study was to determine the complication rates and surgical outcomes stratified by race and ethnicity among patients undergoing colorectal surgery with intestinal stoma creation. Method The ACS NSQIP database from 2013 to 2016 was used. Colon, rectum and small bowel cases requiring intestinal stoma creation were selected. Both African‐American and other groups of minority patients were compared with Caucasian patients using a complex multivariable analysis model. Primary outcomes of interest were complication rates, mortality and extended hospital length of stay. Results The study included 38 088 admissions. After multivariable analysis, African‐American patients still had a prolonged length of hospital stay and higher complication rates. Other minorities also had a prolonged length of hospital stay and higher complication rates. Conclusions Both African‐American and other groups of minority patients requiring an ostomy suffer significantly higher postoperative complication rates and a prolonged hospital length of stay, even after comorbidity adjustment. Access to care, socioeconomic status and comorbid disease management are all important factors for minority patients who undergo colorectal surgery requiring intestinal stoma construction.

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Section: Discussionsupporting

confidence: 79%

Racial disparities after stoma construction in colorectal surgery

et al. 2020

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“…35 Given the structure of the NRD, we were also unable to evaluate provider factors that may have contributed to readmission, including early discharge from the index hospitalization or treatment plans that may have led to worse outcomes including readmission. While future approaches to decreasing readmission will likely require multidisciplinary approaches, a continued focus on provider decision making during the hospitalization and discharge planning will remain a key point in improving outcomes among hospitalized patients with IBD.…”

Section: Discussionmentioning

confidence: 99%

Modifiable Risk Factors for Hospital Readmission Among Patients with Inflammatory Bowel Disease in a Nationwide Database

Barnes

Kochar

Long

et al. 2017

Inflammatory Bowel Diseases

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Background Prior studies suggest that disease activity alone does not reliably predict hospital readmission among patients with inflammatory bowel diseases (IBD). Using a national database, we aimed to further describe the burden of readmissions for IBD and identify modifiable risk factors. Methods We performed a retrospective cohort study using 2013 data from the Nationwide Readmission Database (NRD). Using International Classification of Diseases-9th Revision, Clinical Modification (ICD-9-CM) codes, we identified adult patients with discharge diagnoses of ulcerative colitis (UC) or Crohn's disease (CD) and ascertained diagnoses of anxiety, depression, chronic pain, tobacco use, and other comorbidites during index admission. Logistic regression was used to estimate factors associated with hospital readmission. Results Among 52,498 hospitalizations of IBD patients (63% CD and 37% UC), 12,407 (24%) were readmitted within 90 days of the index hospitalization resulting in roughly $576 million in excess charges. In multivariable analysis of patients with CD, anxiety (OR 1.31, 95%CI:1.21–1.43), depression (OR 1.27, 95%CI:1.07–1.50), chronic pain (OR 1.31, 95%CI:1.18–1.46), and tobacco abuse (OR 1.13, 95%CI:1.06–1.22) were associated with a significant increase in odds of readmission. Among patients with UC, anxiety (OR 1.28, 95%CI:1.14–1.45), depression (OR 1.35, 95%CI:1.07–1.70), and chronic pain (OR 1.44, 95%CI:1.21–1.73) were associated with a significant increase in odds of readmission. Conclusions Readmission occurs frequently in patients with IBD, and is costly. Anxiety, depression, and chronic pain may represent targets for interventions to prevent 90 day hospital readmission in this population.

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“…In one study which used the targeted colectomy dataset from 2012 to 2013, black race was associated with a 60% higher postoperative readmission rate than white race after IBD surgery when controlling for other factors, demonstrating the effects of race and possibly socioeconomic status on outcomes in IBD surgery. 36 Arsoniadis et al further showed that African Americans had a higher complication rate after surgery for CD and that this disparity only disappeared when controlling for comorbidities and ASA score, underscoring some of the health issues associated with racial disparities. 37 The inadequacies of NSQIP, in its current state, are laid most bare when analyzing the outcomes after ileal pouchanal anastomosis (IPAA) surgery for CUC.…”

Section: Inflammatory Bowel Diseasementioning

confidence: 99%

Using the National Surgical Quality Improvement Project (NSQIP) to Perform Clinical Research in Colon and Rectal Surgery

Eisenstein

Stringfield

Holubar

2019

Clinics in Colon and Rectal Surgery

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The American College of Surgeons' National Surgical Quality Improvement Project (ACS-NSQIP) is probably the most well-known surgical database in North American and worldwide. This clinical database was first proposed by Dr. Clifford Ko, a colorectal surgeon, to the ACS, and NSQIP first started collecting data ca. 2005 with the intent of comparing hospitals (benchmarking) and for hospital-level quality improvement projects. Since then, its popularity has grown from just a few participating hospitals in the United States to more than 708 participating hospitals worldwide, and collaboration allows regional or disease-specific data sharing. Importantly, from a methodological perspective, as the number of hospitals has grown so has the hospital heterogeneity and thus generalizability of the results and conclusions of the individual studies. In this article, we will first briefly present the structure of the database (aka the Participant User File) and other important methodological considerations specific to performing clinical research. We will then briefly review and summarize the approximately 60 published colectomy articles and 30 published articles on proctectomy. We will conclude with future directions relevant to colorectal clinical research.

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Racial Disparities in Readmissions for Patients with Inflammatory Bowel Disease (IBD) After Colorectal Surgery

Cited by 37 publications

References 38 publications

Racial disparities after stoma construction in colorectal surgery

Racial disparities after stoma construction in colorectal surgery

Modifiable Risk Factors for Hospital Readmission Among Patients with Inflammatory Bowel Disease in a Nationwide Database

Using the National Surgical Quality Improvement Project (NSQIP) to Perform Clinical Research in Colon and Rectal Surgery

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