M. Ma1, K. Feng1, L. N. Wood1, L. E. Goss1, J. S. Richman1, D. I. Chu1 1University Of Alabama at Birmingham,Surgery,Birmingham, Alabama, USA
Introduction: At least 3.1 million people in the US suffer from IBD, which includes Crohn’s Disease and Ulcerative Colitis. While racial/ethnic disparities in surgical outcomes have been observed in many diseases such as cancer, it is unclear if surgical disparities exist in IBD. The objective of this study was to investigate racial/ethnic disparities in surgical outcomes in a contemporary population of Caucasian-, African-, and Asian-Americans patients. We hypothesized that disparities would exist with certain racial/ethnic groups having worse outcomes.
Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for 2011-2015 was queried for all patients who underwent surgery for IBD. Patient and procedure-level characteristics were included. The primary outcomes were post-operative complications (POCs) and length-of-stay (LOS). Bivariate tests and adjusted logistic and negative binomial regression were used to identify associations between racial/ethnic status and these outcomes.
Results: Of 7,091 patients who underwent colorectal surgery for IBD, racial/ethnic groups included Caucasian-Americans (CA, 90.3%), African-Americans (AfA, 8.63%) and Asian-Americans (AsA, 1.07%). Asian-Americans were more likely to be normal weight (defined as 18<BMI<25; 50.7% versus 40.1%–AfA and 42.9%–CA, p<0.001), not smoke (94.7% versus 74.2%–AfA and 80%–CA, p<0.001), and have lower ASA score of 1 or 2 (61.8% versus 52.8%–AfA and 57.4%–CA, p<0.001). African-Americans had the highest rates of complication due to ileus, sepsis, and bleeding requiring transfusion. Asian- and African-American patients comparatively also had longer post-operative LOS. On multivariate analyses—with Caucasian-Americans as reference category—African-American race remained independently associated with more post-operative ileus (OR=1.43, p=0.0005), sepsis (OR=1.71, p<0.001), and bleeding complications requiring transfusion (OR=1.65, p<0.001). With Asian-American race as reference group, it remained independently associated with a 14% increase in LOS as compared to Caucasian-American patients (IRR 1.14, p<0.001).
Conclusion: African-Americans undergoing surgery for IBD had higher rates of POCs including ileus, sepsis, and bleeding requiring transfusion when compared to Caucasian- and Asian-Americans. This population may represent a particularly high-risk group for poor outcomes and further studies are needed to understand and develop interventions to improve these outcomes.
