M. Ma1, K. Feng1, L. E. Goss1, L. N. Wood1, J. S. Richman1, M. S. Morris1, J. A. Cannon1, G. D. Kennedy1, D. I. Chu1 1University Of Alabama at Birmingham,Surgery,Birmingham, Alabama, USA
Introduction: The US incidence of diverticular disease is increasing and surgery remains a key treatment option. While racial/ethnic disparities in surgical outcomes have been observed for diseases such as cancer, it remains unclear if surgical disparities exist for diverticular patients. This study aims to characterize racial/ethnic disparities that may exist between Caucasian-, African-, and Asian-Americans who have undergone surgery for diverticular disease. 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 patients who underwent surgery for diverticular disease. Patient and procedure-level characteristics were included. The primary outcomes were 30-day mortality, 30-day readmission, 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 20,318 patients who underwent surgery for diverticular disease, 91.5% were Caucasian-American (CA), 7.4% African-American (AfA), and 1.1% Asian-American (AsA). Asian-Americans were more likely to be normal weight (defined as 18<BMI<25; 36.6% versus 15.6%–AfA and 23.4%–CA, p<0.001), not smoke (86.9% versus 73%–AfA and 79.3%–CA, p<0.001), have lower ASA score of 1-2 (57.5% versus 41.5%–AfA and 56.4%–CA, p<0.001), and shorter operation-time (150 min versus 190 min—AfA and 166 min—CA, p<0.001). There were no differences in 30-day mortality, but African-Americans had longer post-operative LOS and higher 30-day readmission rates. African-Americans had higher rates of ileus, respiratory complications, sepsis, and bleeding requiring transfusion. On multivariate analyses—with Caucasian-Americans as reference category—African-American race remained independently associated with more post-operative ileus (OR=1.85, p<0.001), respiratory (OR=1.50, p=0.0004), sepsis (OR=1.63, p<0.001), and bleeding complications (OR=2.17, p<0.001). With African-American race as reference group, it remained independently associated with an 8% increase in LOS as compared to Caucasian-American patients (IRR 1.08, p<0.001).
Conclusion: African-Americans undergoing surgery for diverticular disease had the highest rates of 30-day readmission, LOS, and POCs including ileus, respiratory, sepsis, and bleeding complications when compared to Caucasian- and Asian-Americans. Further studies are needed to understand these observations and to develop interventions to eliminate these disparities.
