Race and Surgical Outcomes

Maura M passed on an article released on Medscape on November 17, 2008 as a CME activity. The article featured on medscape is:

Esnaola, N.F., Hall, B.L., Hosokawa, P.W. et al. (2008). Race and surgical outcomes: It's not all black and white. Annals of Surgery, 248, 247-655.

The objective of this study was to evaluate the INDEPENDENT influence of race on morbidity and mortality following general surgher. The investigator's hypothesis was that in previous studies, the observed effect of race may have been due to confounding effects of co-morbidity.

The authors argue that most studies published on the effect of race on outcomes depend on administrative data which is limited in the amount of clinical information and therefore cannot control adequately for underlying comorbidities.

All non-Hispanic White (34,141) and African American (5068) general surgery patients who were included in the National Surgery Quality Improvement Program (NSQIP) Patient Safety in Surgery Study (2001-2004) were included in the study.

Data was collected on 97 variables (3 demographic, 41 pre-op risk factors, 13 pre-op lab variable; 15 intra-operative variables, and 25 post op occurrences.

30-day post-operative mortality (all-cause) and 30-day morbidity (neuro, cardiac, respiratory, infectious, wound complications) was primary dependent variable.

Key findings: African Americans more likely to undergo emergency surgery and to present with co-morbidities (hypertension, dyspnes, diabetes, renal failure, open wounds, or advanced American Society of Anesthesiology class). African Americans also more likely to undergo less complex procedures, but have higher 30-day morbidity. However, after controlling for comorbidities, African American race DID NOT effect race (OR = 0.95; 95% CI = 0.74 -1.23). African American race was associated with a higher risk of postoperative cardiac arrest and renal insufficency/failure (even after controlling for comorbidity.

The authors suggest that in order to improve health care disparities, the focus should be on improving peri-operative management of c0-morbid conditions.