The effect of race on postsurgical ambulatory medical follow-up among United States Veterans

Abstract

Study Objective To investigate the association between self-identified Black or African-American race and the presence of ambulatory internal medicine follow-up in the year after surgery. Our hypothesis was that among US Veterans who presented for surgery, Black or African-American race would be associated with a decreased likelihood to receive ambulatory internal medicine follow-up in the year after surgery. Design Retrospective observational Setting All United States Veterans Affairs hospitals Patients 236,200 Veterans undergoing surgery between 2006–2011 who were discharged within 10 days of surgery and survived the full 1-year exposure period. Interventions none Measurements Attendance at an internal medicine follow-up appointment within 1 year after surgery. Main Results After controlling for year of surgery, age, age≥ 65 years, gender, Hisp anic ethnicity, and number of inpatient days, Black or African-American patients were 11% more likely to lack internal medicine follow-up after surgery (adjusted odds ratio 1.11; 95%CI 1.06–1.16). When accounting for geographic region, this difference remained significant at the Bonferoni corrected p<0.007 level only in the Midwest United States where Black or African-American patients were 28% more likely to lack medical follow-up in the year after surgery (OR 1.28; 95%CI 1.16–1.42; p<0.0001). Conclusions The disparity in ambulatory medical follow-up following surgery among Black or African-American versus non-Black or African-American veterans in the Midwest region deserves further study and may lead to important quality improvement initiatives aimed specifically at this population.

The impact of health literacy on shared decision making before elective surgery: a propensity matched case control analysis

“…Poor health literacy has been associated with poor health outcomes (e.g., hospitalizations, readmissions and mortality) in medical patients [2–4]. Health literacy directly affects patients’ ability to navigate complex health care systems, to make informed decisions and provide self-care [5]. It is, therefore, expected that poor health literacy can have a large impact on the care and health outcomes of surgical patients who often need to follow important instructions during the perioperative phases [6–9].…”

Impact of Racial Disparities in Preoperative Cardiovascular Evaluation and Surgical Outcomes in Patients Undergoing Metabolic and Bariatric Surgery: A Retrospective Cohort Analysis

“…Both racial groups had a similar breakdown of surgeries (Roux‐en‐Y versus sleeve gastrectomy) and similar baseline comorbidities. Explanations for this early difference could include acute or subacute racial differences in metabolic response to surgery, as have been identified in at least 1 prior study 28 ; differences in postsurgical follow‐up, as have been observed after other surgical interventions 29 ; or other racial differences in immediate postoperative management. That the racial difference in weight loss evened at 12 months may belie an as‐of‐yet unidentified opportunity in the weeks postoperatively to improve postoperative weight loss for Black, Hispanic, or other racial or ethnic groups of patients.…”

The effect of health literacy on patient’s perceived shared decision‐making among Chinese cancer patients

“…8 It can directly affect individuals' ability to navigate complex healthcare systems to make informed decisions. 9 Health literacy was found to be an important determinant of SDM among different populations such as diabetic patients 10 and elderly cancer patients. 11 Patients with a higher level of health literacy have a higher likelihood of participating in SDM.…”

“…Health literacy entails people’s knowledge, motivation, and competences to access, understand, appraise, and apply health information in order to make judgments and take decisions in everyday life concerning health care, disease prevention, and health promotion 8 . It can directly affect individuals’ ability to navigate complex healthcare systems to make informed decisions 9 . Health literacy was found to be an important determinant of SDM among different populations such as diabetic patients 10 and elderly cancer patients 11 .…”