Do outcomes in emergency general surgery vary for minority patients based on surgeons' racial/ethnic case mix?

Autor: Udyavar NR; Center for Surgery and Public Health, Brigham & Women's Hospital, 1620 Tremont Street, 4-020, Boston, MA, 02120, USA. Electronic address: nudyavar@bwh.harvard.edu., Salim A; Center for Surgery and Public Health, Brigham & Women's Hospital, 1620 Tremont Street, 4-020, Boston, MA, 02120, USA; Department of Surgery, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA., Cornwell EE 3rd; Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20059, USA., Cooper Z; Center for Surgery and Public Health, Brigham & Women's Hospital, 1620 Tremont Street, 4-020, Boston, MA, 02120, USA; Department of Surgery, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA., Haider AH; Center for Surgery and Public Health, Brigham & Women's Hospital, 1620 Tremont Street, 4-020, Boston, MA, 02120, USA; Department of Surgery, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2019 Jul; Vol. 218 (1), pp. 42-46. Date of Electronic Publication: 2019 Jan 09.
DOI: 10.1016/j.amjsurg.2019.01.001
Abstrakt: Background: We hypothesized that Black and Hispanic patients undergoing Emergency General Surgery (EGS) with surgeons who treat higher proportions of minority patients will experience better outcomes.
Methods: Using the Florida State Inpatient Database (2010-2014), we performed multivariable regression to assess complications in patients undergoing EGS as a function of patient race and the proportion of Black, Hispanic, or White patients treated by the surgeon during the study period. Analyses were clustered by hospital and adjusted for patient age, comorbidities, sex, insurance, and hospital-level variables.
Results: 5471 surgeons were distributed across 204 hospitals. Of the 520,024 patients included, 67% were White, 16.5% were Black, and 14.2% were Hispanic. For non-White patients undergoing EGS, the increased likelihood of sustaining a complication relative to White patients (OR 1.09, 95% confidence interval [CI] 1.07-1.11) decreased when treated by surgeons whose caseload consisted of higher proportions of Black/Hispanic patients (aOR 0.88, 95% CI 0.78-0.99).
Conclusion: Black patients undergoing EGS are at higher risk for experiencing complications when treated by surgeons whose caseload consists of higher proportions of White patients.
(Copyright © 2019. Published by Elsevier Inc.)
Databáze: MEDLINE
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