A National Inpatient Sample Analysis of Racial Disparities After Segmental Colectomy for Inflammatory Colorectal Diseases
BACKGROUND: Racial disparities and poor access to care are common among African Americans (AA), potentially adversely affecting surgical outcomes in inflammatory bowel conditions. We aimed to analyze the effect of race on outcomes in patients undergoing segmental colectomy for inflammatory bowel conditions.
METHODS: Retrospective review of data from the National Inpatient Sample between 2010 and 2015 identified patients who underwent segmental colectomy without ostomy for Crohn's or diverticular disease. AA patients were compared with Caucasians using a multivariable analysis model. Primary outcomes of interest were overall complications, mortality, and extended hospital stay.
RESULTS: 38,143 admissions were analyzed; AA patients constituted 8% of the overall cohort. Diagnoses included Crohn's (11%) and diverticular disease (89%). After multivariable analysis, AA patients had significantly higher overall risk of complications (OR = 1.27; 95% CI, 1.15-1.40) and extended hospital stay (OR = 1.59; 95% CI, 1.45-1.75) than Caucasians. On bivariate analysis, there was no significant difference in mortality between AA and Caucasian patients. AA patients had significantly higher rates of Medicaid insurance (14% vs 6%, P < .001), lower rates of private insurance (35% vs 47%, P < .001), and were less likely to undergo surgery at a private hospital (31% vs 41%, P < .001).
CONCLUSIONS: AA patients requiring segmental colectomy for inflammatory colorectal conditions experience significantly higher rates of postoperative complications, longer hospital stays, and lower rates of private insurance. Direct correlation between insurance status and postoperative outcomes could not be established, but we speculate such great disparity in outcomes may stem from these socioeconomic differences.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:89 |
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| Enthalten in: |
The American surgeon - 89(2023), 12 vom: 10. Dez., Seite 5131-5139 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Frieder, Joel S [VerfasserIn] |
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| Links: |
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| Themen: |
African American |
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| Anmerkungen: |
Date Completed 08.01.2024 Date Revised 08.01.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1177/00031348221138085 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM348631995 |
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| 245 | 1 | 2 | |a A National Inpatient Sample Analysis of Racial Disparities After Segmental Colectomy for Inflammatory Colorectal Diseases |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Racial disparities and poor access to care are common among African Americans (AA), potentially adversely affecting surgical outcomes in inflammatory bowel conditions. We aimed to analyze the effect of race on outcomes in patients undergoing segmental colectomy for inflammatory bowel conditions | ||
| 520 | |a METHODS: Retrospective review of data from the National Inpatient Sample between 2010 and 2015 identified patients who underwent segmental colectomy without ostomy for Crohn's or diverticular disease. AA patients were compared with Caucasians using a multivariable analysis model. Primary outcomes of interest were overall complications, mortality, and extended hospital stay | ||
| 520 | |a RESULTS: 38,143 admissions were analyzed; AA patients constituted 8% of the overall cohort. Diagnoses included Crohn's (11%) and diverticular disease (89%). After multivariable analysis, AA patients had significantly higher overall risk of complications (OR = 1.27; 95% CI, 1.15-1.40) and extended hospital stay (OR = 1.59; 95% CI, 1.45-1.75) than Caucasians. On bivariate analysis, there was no significant difference in mortality between AA and Caucasian patients. AA patients had significantly higher rates of Medicaid insurance (14% vs 6%, P < .001), lower rates of private insurance (35% vs 47%, P < .001), and were less likely to undergo surgery at a private hospital (31% vs 41%, P < .001) | ||
| 520 | |a CONCLUSIONS: AA patients requiring segmental colectomy for inflammatory colorectal conditions experience significantly higher rates of postoperative complications, longer hospital stays, and lower rates of private insurance. Direct correlation between insurance status and postoperative outcomes could not be established, but we speculate such great disparity in outcomes may stem from these socioeconomic differences | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a African American | |
| 650 | 4 | |a Caucasian | |
| 650 | 4 | |a Crohn’s disease | |
| 650 | 4 | |a colorectal surgery | |
| 650 | 4 | |a diverticular disease | |
| 650 | 4 | |a racial disparity | |
| 650 | 4 | |a segmental resection | |
| 700 | 1 | |a Montorfano, Lisandro |e verfasserin |4 aut | |
| 700 | 1 | |a De Stefano, Felice |e verfasserin |4 aut | |
| 700 | 1 | |a Ortiz Gomez, Camila |e verfasserin |4 aut | |
| 700 | 1 | |a Ferri, Francisco |e verfasserin |4 aut | |
| 700 | 1 | |a Liang, Hong |e verfasserin |4 aut | |
| 700 | 1 | |a Gilshtein, Hayim |e verfasserin |4 aut | |
| 700 | 1 | |a Rosenthal, Raul J |e verfasserin |4 aut | |
| 700 | 1 | |a Wexner, Steven D |e verfasserin |4 aut | |
| 700 | 1 | |a Sharp, Stephen P |e verfasserin |4 aut | |
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