Racial/ethnic disparities in emergency general surgery: explained by hospital-level characteristics?

Erin C Hall; Zain G Hashmi; Syed Nabeel Zafar; Cheryl K Zogg; Edward E Cornwell 3rd; Adil H Haider

doi:10.1016/j.amjsurg.2014.11.005

Racial/ethnic disparities in emergency general surgery: explained by hospital-level characteristics?

Am J Surg. 2015 Apr;209(4):604-9. doi: 10.1016/j.amjsurg.2014.11.005. Epub 2015 Jan 14.

Authors

Erin C Hall¹, Zain G Hashmi², Syed Nabeel Zafar², Cheryl K Zogg³, Edward E Cornwell 3rd⁴, Adil H Haider⁵

Affiliations

¹ Georgetown University School of Medicine, Washington, DC, USA; Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Center for Surgery and Public Health, Harvard Medical School & Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
⁴ Department of Surgery, Howard University School of Medicine, Washington, DC, USA.
⁵ Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: [email protected].

PMID: 25683233
DOI: 10.1016/j.amjsurg.2014.11.005

Abstract

Background: To quantify racial/ethnic differences in outcome after emergency general surgery (EGS).

Methods: Patients receiving a representative EGS (colectomy, small bowel resection, or ulcer repair operation) performed within the first 24 hours of hospital admission were identified in the Nationwide Inpatient Sample between 2000 and 2008. Multivariable logistic regression was used to estimate the overall disparity in odds of death between African Americans (AAs) and Caucasians. Hierarchical models were then used to evaluate association of hospital-level factors and death after EGS.

Results: A total of 116,344 patients were identified. AA patients had 10% higher odds of dying after EGS than Caucasian patients (adjusted odds ratio 1.10, P = .02). All patients treated at hospitals with greater than 6% AA EGS patients had higher odds of death than those at hospitals with fewer percentage of AA EGS patients (adjusted odds ratio 1.16 to 1.42, P < .002).

Conclusion: There is racial/ethnic disparity in outcome after selected EGS; however, this disparity is explained by hospital-level factors.

Keywords: Emergency general surgery; Hierarchical modeling; Hospital-level effects; Racial disparity.

Publication types

Comparative Study

MeSH terms

Adolescent
Adult
Aged
Black or African American
Child
Child, Preschool
Ethnicity*
Female
General Surgery / statistics & numerical data*
Healthcare Disparities / statistics & numerical data*
Hospitals*
Humans
Infant
Male
Middle Aged
Racial Groups*
White People
Young Adult