Racial and Ethnic Postoperative Outcomes After Surgery: The Hispanic Paradox.

Autor: Eguia E; Department of Surgery, Loyola University Medical Center, Maywood, Illinois; One: MAP Division of Clinical Informatics and Analytics, Department of Surgery, Loyola University Chicago, Maywood, Illinois. Electronic address: emanuel.eguia@lumc.edu., Cobb AN; Department of Surgery, Loyola University Medical Center, Maywood, Illinois; One: MAP Division of Clinical Informatics and Analytics, Department of Surgery, Loyola University Chicago, Maywood, Illinois., Kirshenbaum EJ; Department of Surgery, Loyola University Medical Center, Maywood, Illinois., Afshar M; Department of Pulmonary and Critical Care, Loyola University Medical Center, Maywood, Illinois., Kuo PC; Department of Surgery, University of South Florida, Tampa, Florida.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2018 Dec; Vol. 232, pp. 88-93. Date of Electronic Publication: 2018 Jul 03.
DOI: 10.1016/j.jss.2018.05.074
Abstrakt: Background: The Hispanic population in the United States have previously been shown to have, in some cases, better health outcomes than non-Hispanic whites (NHWs) despite having lower socioeconomic status and higher frequency of comorbidities. This epidemiologic finding is coined as the Hispanic Paradox (HP). Few studies have evaluated if the HP exists in surgical patients. Our study aimed to examine postoperative complications between Hispanic and NHW patients undergoing low- to high-risk procedures.
Materials and Methods: We conducted a retrospective cohort study analyzing adult patients who underwent high-, intermediate-, and low-risk procedures. The Healthcare Cost and Utilization Project California State Inpatient Database between 2006 and 2011 was used to identify the patient cohort. Candidate variables for the adjusted model were determined a priori and included patient demographics with the ethnic group as the exposure of interest.
Results: The median age for Hispanics was 52 (SD 19.3) y, and 38.8% were male (n = 87,837). A higher proportion of Hispanics had Medicaid insurance (23.9% versus 3.8%) or were self-pay (14.2% versus 4.5%) compared with NHWs. In adjusted analysis, Hispanics had a higher odds risk for postoperative complications across all risk categories combined (OR 1.06, 95% CI 1.04-1.09). They also had an increased in-hospital (OR 1.38, 95% CI 1.14-1.30) and 30-d mortality in high-risk procedures (OR 1.34, 95% CI 1.19-1.51).
Conclusions: Hispanics undergoing low- to high-risk surgery have worse outcomes compared with NHWs. These results do not support the hypothesis of an HP in surgical outcomes.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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