E. Eguia1, A. Cobb1, E. Kirshenbaum1, P. C. Kuo1 1Loyola University Chicago Stritch School Of Medicine,General Surgery,Maywood, IL, USA
Introduction: The Hispanic/Latino population in the United States have previously been shown to have, in some cases, better health outcomes than non-Hispanic Whites despite having lower socioeconomic status and greater frequency of comorbidities. This epidemiologic finding has been coined the “Hispanic Paradox” dating back to 1986. Disparities in social determinants of health between ethnic groups also exist in surgical patients but few studies have evaluated if the Hispanic Paradox exists in this cohort. The aim of our study was to examine postoperative complications between Hispanic and non-Hispanic patients undergoing high and low risk procedures.
Methods: We conducted a retrospective cohort study analyzing adult patients who underwent high (Esophagectomy, Pancreatectomy, Abdominal Aortic Aneurysm Repair (AAA)) and low risk procedures (Appendectomy and Cholecystectomy). The patient cohort was derived from the California Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) between 2006 and 2011. Patient administrative data were linked with baseline characteristics from the American Hospital Association Database. Candidate variables for the adjusted model were determined a priori and included patient demographics with ethnic group as the exposure of interest. Analysis was performed in a mixed effects multivariable logistic regression.
Results: Hispanic patients had lower median income and greater proportions with Medicaid or no insurance. In adjusted analysis, Hispanics had lower odds of post-operative complications from high-risk procedures such as Esophagectomy, Pancreatectomy and AAA repair (0.74 CI 0.57-0.96, 0.47 CI 0.28-0.76, 0.35 CI 0.26-0.45). The odds ratio for major post-operative complications from both low and high-risk procedures were no different between Hispanics and non-Hispanics. Hispanics had greater odds of in-hospital death after an Esophagectomy but no difference after Appendectomy, Pancreatectomy or AAA repair when compared to non-Hispanics. In contrast, Hispanics had lower odds of in-hospital death after Cholecystectomy (0.69 CI 0.48-0.98).
Conclusion: Hispanics had a lower odds risk or no differences in odds risk for in-hospital death or developing postoperative complications compared to non-Hispanic patients suggestive of a Hispanic paradox in surgical outcomes. Future studies are needed to further elucidate these mechanism given that US Hispanic/Latino surgical population is a diverse race which come from a variety of cultures, backgrounds, immigrant generational status and socioeconomic characteristics. Lastly, given the limited health data on Hispanics, Surgical Disparities Research should focus on improving data collection strategies.