C. E. Sharoky1, M. M. Sellers1, J. H. Fieber1, C. J. Wirtalla1, G. E. Tasian2, R. R. Kelz1 1University Of Pennsylvania,Department Of Surgery, Center For Surgery And Health Economics,Philadelphia, PA, USA 2Perelman School Of Medicine,Center For Clinical Epidemiology And Biostatistics,Philadelphia, PA, USA
Introduction: Racial disparities exist in the management of many acute medical conditions. Prior studies examining racial disparities in emergency general surgery (EGS) have pointed to hospital-level factors as major contributors. We sought to examine whether racial disparities in death and serious morbidity (DSM) after EGS exist independent of hospital-level and geographic factors.
Methods: Using Florida inpatient hospital discharge claims (2010-2013), we identified all patients ≥18 with an EGS condition admitted through the emergency department who had an EGS operation ≤2 days from admission. Multivariable logistic regression with multilevel mixed effects to control for both the county and specific hospital where care was received was used to estimate the association between race and DSM in black patients (BL) compared to white patients (WH). Two subgroup analyses, one of urban counties and one of rural counties, were performed to examine geographic variation in the association between race and DSM.
Results: A total of 154,377 patients were identified, of which 17,540 (11%) were BL. Compared to WH, BL had 16% increased odds of DSM (95%CI 1.10,1.25) after adjusting for patient comorbidities, severity of illness on presentation, EGS operation performed, county and hospital. In a subgroup of urban counties, BL had 23% increased odds of DSM (95%CI 1.11,1.36) compared to WH. In a subgroup of rural counties, BL had a 17% increased odds of DSM (95%CI 1.01,1.35) compared to WH.
Conclusion: Black race is associated with increased DSM after EGS, and this association holds true in both urban and rural regions. This suggests that racial disparities in EGS exist even when controlling for the county and hospital where patients receive care. Further research is needed to identify processes of care that underlie these associations to help improve racial disparities in EGS across hospitals and geographic regions.
