Racial Disparities in Surgery

Azin, Arash; Hirpara, Dhruvin H.; Doshi, Sachin; Chesney, Tyler R.; Quereshy, Fayez A.; Chadi, Sami A.

doi:10.1097/as9.0000000000000023

Cited by 33 publications

(19 citation statements)

References 36 publications

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“…Racial disparities have also been demonstrated in orthopaedic surgery and other surgical specialties. The increased risk of nonhome discharge in Black and Asian patients may represent a proxy for the increased risk associated with socioeconomic factors which increase risk of postoperative complications 34,35 .…”

Section: Discussionmentioning

confidence: 99%

Are All Patients Going Home after Total Knee Arthroplasty? A Temporal Analysis of Discharge Trends and Predictors of Nonhome Discharge (2011–2020)

Pan

Rullán

et al. 2023

J Knee Surg

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Background: Value-based orthopedic surgery and reimbursement changes for total knee arthroplasty (TKA) are potential factors shaping arthroplasty practice nationwide. This study aimed to evaluate: (1) trends in discharge disposition (home versus non-home discharge), (2) episode-of-care outcomes for home and non-home discharge cohorts, and (3) predictors of non-home discharge among patients undergoing TKA from 2011 to 2020. Methods: The National Surgical Quality Improvement Program database was reviewed for all primary TKAs from 2011 to 2020. A total of 462,858 patients were identified and grouped into home discharge(n=378,771) and non-home discharge(n=84,087) cohorts. The primary outcome was the annual rate of home/non-home discharges. Secondary outcomes included trends in healthcare utilization parameters, readmissions, and complications. Multivariable logistic regression analyses were performed to evaluate factors associated with non-home discharge. Results: Overall, 82% were discharged home, and 18% were discharged to a non-home facility. Home discharge rates increased from 65.5% in 2011 to 94% in 2020. Non-home discharge rates decreased from 34.5% in 2011 to 6% in 2020. Thirty-day readmissions decreased from 3.2% to 2.4% for the homedischarge cohort but increased from 5.6% to 6.1% for the non-home discharge cohort. Female sex, Asian or Black Race, Hispanic ethnicity, ASA class >II, Charlson Comorbidity Index scores > 0, smoking, dependent functional status, and age >60 were associated with higher odds of non-home discharge. Conclusion: Over the last decade there has been a major shift to home discharge after TKA. Future work is needed to further assess if perioperative interventions may have a positive effect in decreasing adverse outcomes in non-home discharge patients. Keywords: Knee Arthroplasty; nationwide trends; discharge disposition; predictors; outcomes

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Section: Discussionmentioning

confidence: 99%

Are All Patients Going Home after Total Knee Arthroplasty? A Temporal Analysis of Discharge Trends and Predictors of Nonhome Discharge (2011–2020)

Pan

Rullán

et al. 2023

J Knee Surg

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“…It has been found that spastic hip dysplasia is more common and more severe in higher classifications of GMFCS 30. This is particularly concerning when considering Black race is associated with 20-50% higher rates of all-cause morbidity and reoperation in the 30 days after surgery, irrespective of functional impairment 31. For further analysis, it would be helpful to identify data sources that provide GMFCS data to include in the regression model on race and risk for salvage procedures.…”

Section: Discussionmentioning

confidence: 99%

“…30 This is particularly concerning when considering Black race is associated with 20-50% higher rates of all-cause morbidity and reoperation in the 30 days after surgery, irrespective of functional impairment. 31 For further analysis, it would be helpful to identify data sources that provide GMFCS data to include in the regression model on race and risk for salvage procedures. We believe that these previous works do have some relation to our data.…”

Section: Discussionmentioning

confidence: 99%

Race Is Associated With Risk of Salvage Procedures and Postoperative Complications After Hip Procedures in Children With Cerebral Palsy

Brown

Cho

Tarawneh

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Despite the many surgical interventions available for spastic hip dysplasia in children with cerebral palsy, a radical salvage hip procedure may still ultimately be required. The purpose of this study was to assess whether race is an independent risk factor for patients with cerebral palsy to undergo a salvage hip procedure or experience postoperative complications for hip dysplasia treatment. Methods: This is a retrospective cohort analysis utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database from 2012 to 2019. International Classification of Diseases, 9th and 10th Revisions, Clinical Modifications (ICD-9-CM, ICD-10-CM), and current procedural terminology (CPT) codes were used to identify patients with cerebral palsy undergoing hip procedures for hip dysplasia and to stratify patients into salvage or reconstructive surgeries.Results: There was a total of 3906 patients with cerebral palsy between the ages of 2 and 18 years undergoing a procedure for hip dysplasia, including 1995 (51.1%) White patients, 768 (19.7%) Black patients, and 1143 (29.3%) patients from other races. Both Black (P = 0.044) and White (P = 0.046) races were significantly associated with undergoing a salvage versus a reconstructive hip procedure, with Black patients having an increased risk compared to White patients [adjusted odds ratio (OR) 1.77, confidence interval (CI) 1.02-3.07]. Only Black patients were found to have an increased risk of any postoperative complication compared to White patients, with an adjusted OR of 1.26 (CI 1.02-1.56; P = 0.033). Both White (P = 0.017) and black (P = 0.004) races were found to be significantly associated with medical complications, with Black patients having an increased risk (adjusted OR 1.43, CI 1.12-1.84) compared to White patients. There were no significant findings between the race and risk of surgical site complications, unplanned readmissions, or reoperations. Conclusion: This study demonstrates that patient race is an independent association for the risk of pediatric patients with cerebral palsy to both undergo a salvage hip procedure and to experience postoperative medical complications, with Black patients having an increased risk compared to White.

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“…The difference in hospital discharge placement by race has been reported heavily among trauma patients (Asemota et al, 2013; Chiu et al, 2019; Fat et al, 2019). Azin and colleagues emphasize how race plays a significant role in poorer postoperative outcome (Azin et al, 2020). The findings presented and those of others highlight a need for further evaluation of structural determinants of health outcomes for victims of community violence, particularly those that can be disrupted by a policy change at the hospital-level.…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Violent Penetrating Injuries and Long-Term Adverse Outcomes

Nistler

James

Dugan

et al. 2022

J Interpers Violence

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Violent injury is known to be a chronic, recurrent issue, with high rates of recidivism following initial injury. While the burden of violence is disproportionately felt among young Black men and in communities of color, examination of distinct risk factors and long-term outcomes for other racial and ethnic groups could lead to improved violence intervention strategies. In this study, we examined the risk of violent penetrating injury and long-term adverse outcomes by race and ethnicity. This retrospective study was performed using a cohort of patients presenting to the Boston Medical Center emergency department for a violent penetrating injury between 2006 and 2016. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) for the risk of all-cause mortality and violent re-injury at one and 3 years after surviving a penetrating injury. Of the 4191 victims of violent injury, 12% were White, 18% were Hispanic, and the remaining 70% self-identified as Black. Within 3 years after initial injury, Black patients were at the greatest risk of all-cause violent re-injury (vs. Hispanic: HR = 1.46, 95%CI[1.15,1.85], p = 0.002; vs. White: HR = 1.89, 95%CI[1.40,2.57], p < 0.0001), particularly by gunshot wound (vs. Hispanic: HR = 2.04, 95%CI[1.29,3.22] p = 0.002; vs. White: HR = 2.34, 95%CI[1.19,4.60], p = 0.01). At 3-years following initial injury, White patients were at 2.03 times the risk for all-cause mortality, likely due to a 4.96 times greater risk of death by drug or alcohol overdose for White patients compared to Black patients (HR = 4.96, 95%CI[2.25,10.96], p < 0.0001). In conclusion, Black survivors of violent injury have a significantly higher risk of violent re-injury, particularly by gun violence, while White patients are at the highest risk for mortality due to the incidence of drug and alcohol overdose. Violence intervention programs with similar patient populations should explore options to collaborate with drug treatment programs to reach this vulnerable population.

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Racial Disparities in Surgery

Cited by 33 publications

References 36 publications

Are All Patients Going Home after Total Knee Arthroplasty? A Temporal Analysis of Discharge Trends and Predictors of Nonhome Discharge (2011–2020)

Are All Patients Going Home after Total Knee Arthroplasty? A Temporal Analysis of Discharge Trends and Predictors of Nonhome Discharge (2011–2020)

Race Is Associated With Risk of Salvage Procedures and Postoperative Complications After Hip Procedures in Children With Cerebral Palsy

Racial and Ethnic Disparities in Violent Penetrating Injuries and Long-Term Adverse Outcomes

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