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Bonus CG, Hatcher D, Northall T, Montayre J. Using a co-design methodological approach to optimize perioperative nursing care for older adult patients from ethnically diverse backgrounds: a study protocol. Int J Qual Stud Health Well-being 2024; 19:2349438. [PMID: 38709958 DOI: 10.1080/17482631.2024.2349438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/26/2024] [Indexed: 05/08/2024] Open
Abstract
This article outlines the use of a co-design methodological approach aimed at optimizing perioperative care experiences for ethnically diverse older adults and their family carers. The research involved three phases. In Phase 1, the foundation was established with the formation of a Core Advisory Group comprising key informants, including health consumers. This initial phase focused on forming relationships and conducting a literature review to inform subsequent stages of the research. Phase 2 progressed to data collection, where a qualitative survey on perioperative experiences was conducted. Semi-structured interviews were held with patients, their family carers, and perioperative staff. Phase 3 advanced the co-design process through a workshop involving patients, family carers, perioperative staff, and key stakeholders. Workshop participants collaborated on potential practice changes, proposing strategies for future clinical implementation. While data analysis and reporting for Phases 2 and 3 are forthcoming, the continued involvement of the Core Advisory Group ensures ongoing consensus-building on health consumer needs. This methodology article adopts a prospective stance, with findings to be presented in subsequent scholarly works. Use of this methodology will help to determine how the use of a co-design approach may impact the development of culturally responsive perioperative nursing care for those from ethnically diverse communities.
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Affiliation(s)
- Charmaine G Bonus
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Blacktown, NSW, Australia
| | - Deborah Hatcher
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Tiffany Northall
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Jed Montayre
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR
- WHO Collaborating Centre for Community Health Services, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR
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Rice JR, Rothenberg KA, Ramadan OI, Savage D, Kalapatapu V, Julien HM, Schneider DB, Wang GJ. Factors Associated with Urgent Amputation Status and Its Impact on Mortality. Ann Vasc Surg 2024; 105:334-342. [PMID: 38582210 DOI: 10.1016/j.avsg.2023.12.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/11/2023] [Accepted: 12/22/2023] [Indexed: 04/08/2024]
Abstract
BACKGROUND Thirty-day mortality is higher after urgent major lower extremity amputations compared to elective lower extremity amputations. This study aims to identify factors associated with urgent amputations and to examine their impact on perioperative outcomes and long-term mortality. METHODS Patients undergoing major lower limb amputation from 2013 to 2020 in the Vascular Quality Initiative were included. Urgent amputation was defined as occurring within 72 hr of admission. Associations with sociodemographic characteristics, comorbidities, and outcomes including postoperative complication, inpatient death, and long-term survival were compared using univariable tests and multivariable logistic regression. Long-term survival between groups was compared using Kaplan-Meier analysis. RESULTS Of the 12,874 patients included, 4,850 (37.7%) had urgent and 8,024 (62.3%) had elective amputations. Non-White patients required urgent amputation more often than White patients (39.8% vs. 37.9%, P = 0.03). A higher proportion of Medicaid and self-pay patients presented urgently (Medicaid: 13.0% vs. 11.0%; self-pay: 3.4% vs. 2.5%, P < 0.001). Patients requiring urgent amputation were less often taking aspirin (55.6% vs. 60.1%, P < 0.001) or statin (62.2% vs. 67.2%, P < 0.001), had fewer prior revascularization procedures (41.0% vs. 48.8%, P < 0.001), and were of higher American Society of Anesthesiologists (ASA) class 4-5 (50.9% vs. 40.1%, P < 0.001). Urgent amputations were more commonly for uncontrolled infection (48.1% vs. 29.4%, P < 0.001) or acute limb ischemia (14.3% vs. 6.2%, P < 0.001). Postoperative complications were higher after urgent amputations (34.7% vs. 16.6%, P < 0.001), including need for return to operating room (23.8% vs. 8.4%, P < 0.001) and need for higher revision (15.2% vs. 4.5%, P < 0.001). Inpatient mortality was higher after urgent amputation (8.9% vs. 5.4%, P < 0.001). Multivariable analysis revealed non-White race, self-pay, homelessness, current smoking, ASA class 4-5, and amputations for uncontrolled infection or acute limb ischemia were associated with urgent status, whereas living in a nursing home or prior revascularization were protective. Furthermore, urgent amputation was associated with an increased odds of postoperative complication or death (odds ratio 1.86 [1.69-2.04], P < 0.001) as well as long-term mortality (odds ratio: 1.24 [1.13-1.35], P < 0.001). Kaplan-Meier analysis corroborated that elective status was associated with improvement of long-term survival. CONCLUSIONS Patients requiring urgent amputations are more often non-White, uninsured, and less frequently had prior revascularization procedures, revealing disparities in access to care. Urgency was associated with a higher postoperative complication rate, as well as increased long-term mortality. Efforts should be directed toward reducing these disparities to improve outcomes following amputation.
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Affiliation(s)
- Jayne R Rice
- Department of Vascular Surgery and Endovascular Therapy, Hospital of University of Pennsylvania, Philadelphia, PA.
| | - Kara A Rothenberg
- Department of Vascular Surgery and Endovascular Therapy, Hospital of University of Pennsylvania, Philadelphia, PA
| | - Omar I Ramadan
- Department of Vascular Surgery and Endovascular Therapy, Hospital of University of Pennsylvania, Philadelphia, PA
| | - Dasha Savage
- Department of Vascular Surgery and Endovascular Therapy, Hospital of University of Pennsylvania, Philadelphia, PA
| | - Venkat Kalapatapu
- Department of Vascular Surgery and Endovascular Therapy, Hospital of University of Pennsylvania, Philadelphia, PA
| | - Howard M Julien
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of University of Pennsylvania, Philadelphia, PA
| | - Darren B Schneider
- Department of Vascular Surgery and Endovascular Therapy, Hospital of University of Pennsylvania, Philadelphia, PA
| | - Grace J Wang
- Department of Vascular Surgery and Endovascular Therapy, Hospital of University of Pennsylvania, Philadelphia, PA
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Rudisill SS, Hornung AL, Akosman I, Amen TB, Lovecchio FC, Nwachukwu BU. Differences in total shoulder arthroplasty utilization and 30-day outcomes among White, Black, and Hispanic patients: do disparities exist in the outpatient setting? J Shoulder Elbow Surg 2024; 33:1536-1546. [PMID: 38182016 DOI: 10.1016/j.jse.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND In the United States, efforts to improve efficiency and reduce healthcare costs are shifting more total shoulder arthroplasty (TSA) surgeries to the outpatient setting. However, whether racial and ethnic disparities in access to high-quality outpatient TSA care exist remains to be elucidated. The purpose of this study was to assess racial/ethnic differences in relative outpatient TSA utilization and perioperative outcomes using a large national surgical database. METHODS White, Black, and Hispanic patients who underwent TSA between 2017 and 2021 were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Baseline demographic and clinical characteristics were collected, and rates of outpatient utilization, adverse events, readmission, reoperation, nonhome discharge, and mortality within 30 days of surgery were compared between racial/ethnic groups. Race/ethnicity-specific trends in utilization of outpatient TSA were assessed, and multivariable logistic regression was used to adjust for baseline demographic factors and comorbidities. RESULTS A total of 21,186 patients were included, consisting of 19,135 (90.3%) White, 1093 (5.2%) Black, and 958 (4.5%) Hispanic patients and representing 17,649 (83.3%) inpatient and 3537 (16.7%) outpatient procedures. Black and Hispanic patients were generally younger and less healthy than White patients, yet incidences of complications, nonhome discharge, readmission, reoperation, and death within 30 days were similar across groups following outpatient TSA (P > .050 for all). Relative utilization of outpatient TSA increased by 28.7% among White patients, 29.5% among Black patients, and 38.6% among Hispanic patients (ptrend<0.001 for all). Hispanic patients were 64% more likely than White patients to undergo TSA as an outpatient procedure across the study period (OR: 1.64, 95% CI 1.40-1.92, P < .001), whereas odds did not differ between Black and White patients (OR: 1.04, 95% CI 0.87-1.23, P = .673). CONCLUSION Relative utilization of outpatient TSA remains highest among Hispanic patients but has been significantly increasing across all racial and ethnic groups, now accounting for more than one-third of all TSA procedures. Considering outpatient TSA is associated with fewer complications and lower costs, increasing utilization may represent a promising avenue for reducing disparities in orthopedic shoulder surgery.
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Affiliation(s)
| | - Alexander L Hornung
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Izzet Akosman
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Francis C Lovecchio
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Diaz A, Castillo Tafur JC, Lin Y, Echenique DB, Drake B, Choubey AS, Mejia A, Gonzalez MH. Education, Language, and Cultural Concordance Influence Patient-Physician Communication in Orthopaedics. J Bone Joint Surg Am 2024:00004623-990000000-01146. [PMID: 38941477 DOI: 10.2106/jbjs.24.00167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
BACKGROUND Orthopaedic surgery has a diversity gap, as it is not representative of the racial or sex proportions of the U.S. population. This gap can lead to communication barriers stemming from health literacy, language proficiency, or cultural discordance that may contribute to current health inequities. This study assesses the influence of educational attainment, language, and cultural concordance on patient-physician communication. METHODS In this cross-sectional study, 394 patients from an urban orthopaedic clinic were administered a Likert-type survey regarding race or ethnicity, educational level, communication, patient satisfaction, language proficiency, and culture. One-way analysis of variance, chi-square tests, and Welch t tests were used to evaluate responses. RESULTS The majority of subjects identified as African-American/Black (50%) or Hispanic/Latino (30%). Completing high school was associated with a better ability of the subjects to communicate with their orthopaedic surgeon (p < 0.001). Hispanic subjects reported lower English proficiency (p < 0.001) and decreased ability to communicate with their physician (p < 0.001) compared with other subjects, with educational attainment influencing their ability to understand their orthopaedic surgeon in English (p < 0.001). African-American and Hispanic patients placed greater importance on orthopaedic surgeons understanding their culture than White patients (p < 0.001). Hispanic patients who saw a language and culture-concordant surgeon valued having a Spanish-speaking surgeon more than Hispanic patients who did not see a concordant surgeon (p = 0.04). CONCLUSIONS These results suggest that patient-physician language concordance, particularly in patients with lower education, may be essential to delivering high-quality patient care. Hispanic and African-American patients placed significantly greater importance on their orthopaedic surgeons understanding their culture. Hispanic patients frequently sought care with language-concordant surgeons and placed higher value on physicians understanding their culture. To better serve minority communities, efforts should be made to increase orthopaedic surgeons' cultural humility and to recruit a diverse multilingual surgeon workforce. CLINICAL RELEVANCE This research demonstrates that cultural and language concordance, specifically between Hispanic patients and Hispanic, Spanish-speaking surgeons, can significantly enhance patient preference and potentially improve patient satisfaction and outcomes in orthopaedic care. Additionally, it underscores the importance of understanding and addressing the diversity within the field and the patient population to better meet the needs of a multicultural society.
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Affiliation(s)
- Alondra Diaz
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois
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Rehman A, Singh A, Sridhar P, Wang HY, Velo A, Nguyen D, Ehrlich M, Lookstein R, Steiger DJ. Association of race, ethnicity and insurance status with outcomes for patients with acute pulmonary embolism treated by PERT: a retrospective observational study. Respir Res 2024; 25:259. [PMID: 38915033 PMCID: PMC11197331 DOI: 10.1186/s12931-024-02872-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 06/07/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Management of PE has become streamlined with the implementation of PE Response Teams (PERT). Race, ethnicity and insurance status are known to influence the outcomes of patients with acute PE. However, whether the implementation of PERT-based care mitigates these racial and ethnic disparities remains unknown. Our aim was to assess the association of race, ethnicity and insurance with outcomes for patients with acute PE managed by PERT. METHODS We performed a retrospective chart review of 290 patients with acute PE, who were admitted to one of three urban teaching hospitals in the Mount Sinai Health System (New York, NY) from January 2021 to October 2023. A propensity score-weighted analysis was performed to explore the association of race, ethnicity and insurance status with overall outcomes. RESULTS Median age of included patients was 65.5 years and 149 (51.4%) were female. White, Black and Asian patients constituted 56.2% (163), 39.6% (115) and 3.5% [10] of the cohort respectively. Patients of Hispanic or Latino ethnicity accounted for 8.3% [24] of the sample. The 30-day rates of mortality, major bleeding and 30-day re-admission were 10.3%, 2.1% and 12.8% respectively. Black patients had higher odds of major bleeding (odds ratio [OR]: 1.445; p < 0.0001) when compared to White patients. Patients of Hispanic or Latino ethnicity had lower odds of receiving catheter-directed thrombolysis (OR: 0.966; p = 0.0003) and catheter-directed or surgical embolectomy (OR: 0.906; p < 0.0001) when compared to non-Hispanic/Latino patients. Uninsured patients had higher odds of receiving systemic thrombolysis (OR: 1.034; p = 0.0008) and catheter-directed thrombolysis (OR: 1.059; p < 0.0001), and lower odds of receiving catheter-directed or surgical embolectomy (OR: 0.956; p = 0.015) when compared to insured patients, although the odds of 30-day mortality and 30-day major bleeding were not significantly different. CONCLUSION Within a cohort of PE patients managed by PERT, there were significant associations between race, ethnicity and overall outcomes. Hispanic or Latino ethnicity and uninsured status were associated with lower odds of receiving catheter-directed or surgical embolectomy. These results suggest that disparities related to ethnicity and insurance status persist despite PERT-based care of patients with acute PE.
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Affiliation(s)
- Abdul Rehman
- Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ, 07103, USA
| | - Avinash Singh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai Health System, New York City, NY, 10029, USA
| | - Priyanka Sridhar
- Department of Medicine, Icahn School of Medicine at Mount Sinai Health System, New York City, NY, 10029, USA
| | - Hong Yu Wang
- Department of Medicine, Icahn School of Medicine at Mount Sinai Health System, New York City, NY, 10029, USA
| | - Agostina Velo
- Department of Medicine, Icahn School of Medicine at Mount Sinai Health System, New York City, NY, 10029, USA
| | - Destiny Nguyen
- Department of Medicine, Icahn School of Medicine at Mount Sinai Health System, New York City, NY, 10029, USA
| | - Madeline Ehrlich
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai Health System, New York City, NY, 10029, USA
| | - Robert Lookstein
- Department of Radiology, Icahn School of Medicine at Mount Sinai Health System, New York City, NY, 10029, USA
| | - David J Steiger
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai Health System, New York City, NY, 10029, USA.
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Aminpour N, Phan V, Wang H, McDermott J, Valentin M, Mishra A, DeLia D, Noel M, Al-Refaie W. Clinician-to-clinician connectedness and access to gastric cancer surgery at National Cancer Institute-designated cancer centers. J Gastrointest Surg 2024:S1091-255X(24)00480-3. [PMID: 38910084 DOI: 10.1016/j.gassur.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/16/2024] [Accepted: 05/26/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND For patients with gastric cancer, the pathway from primary care (PC) clinician to gastroenterologist to cancer specialist (medical oncologist or surgeons) is referral dependent. The impact of clinician connectedness on disparities in quality gastric cancer care, such as at National Cancer Institute-designated cancer centers (NCI-CC), remains underexplored. This study evaluated how clinician connectedness influences access to gastrectomy at NCI-CC. METHODS Maryland's All-Payer Claims Database was used to evaluate 667 patients who underwent gastrectomy for cancer from 2013 to 2018. Two separate referral linkages, defined as ≥9 shared patients, were examined: (1) PC clinicians to gastroenterologists at NCI-CC and (2) gastroenterologists to cancer specialists at NCI-CC. Multiple logistic regression models determined associations between referral linkages and odds of undergoing gastrectomy at NCI-CC. RESULTS Only 15% of gastrectomies were performed at NCI-CC. Patients of gastroenterologists with referral links to cancer specialists at NCI-CC were more likely to be <65 years, male, White, and privately insured. Every additional referral link between PC clinician and gastroenterologist at NCI-CC and between gastroenterologist and cancer specialist at NCI-CC increased the odds of gastrectomy at NCI-CC by 71% and 26%, respectively. Black patients had half the odds as White patients in receiving gastrectomy at NCI-CC; however, adjusting for covariates including clinician-to-clinician connectedness attenuated this observation. CONCLUSION Patients of clinicians with low connectedness and Black patients are less likely to receive gastrectomy at NCI-CC. Enhancing clinician connectedness is necessary to address disparities in cancer care. These results are relevant to policy makers, clinicians, and patient advocates striving for health equity.
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Affiliation(s)
- Nathan Aminpour
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, United States
| | - Vy Phan
- Georgetown University School of Medicine, Washington, DC, United States
| | - Haijun Wang
- MedStar Health Research Institute, Hyattsville, MD, United States
| | - James McDermott
- Department of Surgery, Stanford University, Stanford, CA, United States
| | - Michelle Valentin
- Georgetown University School of Medicine, Washington, DC, United States
| | - Ankit Mishra
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Derek DeLia
- Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, United States
| | - Marcus Noel
- Department of Medicine, MedStar-Georgetown University Hospital, Washington, DC, United States
| | - Waddah Al-Refaie
- Department of Surgery, Creighton University School of Medicine and CHI Health, Omaha, NE, United States.
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Pennings JS, Oleisky ER, Master H, Davidson C, Coronado RA, Brintz CE, Archer KR. Impact of Racial/Ethnic Disparities on Patient-Reported Outcomes Following Cervical Spine Surgery: QOD Analysis. Spine (Phila Pa 1976) 2024; 49:873-883. [PMID: 38270397 PMCID: PMC11196202 DOI: 10.1097/brs.0000000000004935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
STUDY DESIGN Retrospective analysis of data from the cervical module of a National Spine Registry, the Quality Outcomes Database. OBJECTIVE To examine the association of race and ethnicity with patient-reported outcome measures (PROMs) at one year after cervical spine surgery. SUMMARY OF BACKGROUND DATA Evidence suggests that Black individuals are 39% to 44% more likely to have postoperative complications and a prolonged length of stay after cervical spine surgery compared with Whites. The long-term recovery assessed with PROMs after cervical spine surgery among Black, Hispanic, and other non-Hispanic groups ( i.e . Asian) remains unclear. MATERIALS AND METHODS PROMs were used to assess disability (neck disability index) and neck/arm pain preoperatively and one-year postoperative. Primary outcomes were disability and pain, and not being satisfied from preoperative to 12 months after surgery. Multivariable logistic and proportional odds regression analyses were used to determine the association of racial/ethnic groups [Hispanic, non-Hispanic White (NHW), non-Hispanic Black (NHB), and non-Hispanic Asian (NHA)] with outcomes after covariate adjustment and to compute the odds of each racial/ethnic group achieving a minimal clinically important difference one-year postoperatively. RESULTS On average, the sample of 14,429 participants had significant reductions in pain and disability, and 87% were satisfied at one-year follow-up. Hispanic and NHB patients had higher odds of not being satisfied (40% and 80%) and having worse pain outcomes (30%-70%) compared with NHW. NHB had 50% higher odds of worse disability scores compared with NHW. NHA reported similar disability and neck pain outcomes compared with NHW. CONCLUSIONS Hispanic and NHB patients had worse patient-reported outcomes one year after cervical spine surgery compared with NHW individuals, even after adjusting for potential confounders, yet there was no difference in disability and neck pain outcomes reported for NHA patients. This study highlights the need to address inherent racial/ethnic disparities in recovery trajectories following cervical spine surgery.
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Affiliation(s)
- Jacquelyn S. Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Emily R. Oleisky
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Hiral Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Claudia Davidson
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Rogelio A. Coronado
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Carrie E. Brintz
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN
| | - Kristin R. Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN
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Ghusn W, Mosleh KA, Hage K, Salame M, Gala K, Edwards MA, Kindel TL, Ghanem OM. A comprehensive analysis of health care Inequities in randomized clinical trials following bariatric surgeries. Am J Surg 2024:115796. [PMID: 38871550 DOI: 10.1016/j.amjsurg.2024.115796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/10/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Obesity is a global epidemic, leading to an increasing focus on interventions like bariatric surgeries. Despite this, there's a noticeable gap in understanding the demographic distribution of patients in clinical trials for bariatric surgery. METHODS We conducted a comprehensive analysis of 117 registered randomized clinical trials related to bariatric surgery on ClinicalTrials.gov. We extracted demographic information, including age, sex, race, and ethnicity, and performed descriptive statistical analyses. RESULTS The analysis covered 8,418 participants. The mean age was 43.8 years, with a substantial majority (93.8 %) falling within the 18-65 age group. Females comprised 74.9 % of participants, surpassing real-world estimates. Racially, 65.3 % of participants were White, while African Americans represented 18.5 %, Asians 1.2 %, Native Hawaiians 0.2 %, and American Indians 0.1 %, indicating an underrepresentation of diverse racial groups, notably lower compared to real-world demographic data. In terms of ethnicity, only 17.6 % were Hispanic. CONCLUSIONS This study reveals significant demographic disparities in patients undergoing bariatric surgeries in clinical trials. This suggests a lack of generalizability, emphasizing the need for inclusive recruitment strategies to enhance health equity.
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Affiliation(s)
- Wissam Ghusn
- Department of Internal Medicine, Boston Medical Center, Boston, MA, 02118, USA; Division of Gastroenterology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Marita Salame
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Khushboo Gala
- Division of Gastroenterology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Michael A Edwards
- Advanced GI and Bariatric Surgery Division, Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
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Nasseri YY, La KHT, Oka K, Solis-Pazmino P, Smiley A, Langenfeld S, Cohen J, Barnajian M. Racial disparities in access to minimally invasive proctectomy for rectal cancer-a National Surgical Quality Improvement Program study. Colorectal Dis 2024; 26:1223-1230. [PMID: 38702908 DOI: 10.1111/codi.16994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/24/2023] [Accepted: 03/25/2024] [Indexed: 05/06/2024]
Abstract
AIM The aim of this work was to determine racial disparities in access to minimally invasive proctectomy using a national database. METHOD A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program evaluated for surgical approach (robotic, laparoscopic or open), demographics and comorbidity, and then compared by race. RESULTS A total of 3511 patients (325 Asian, 2925 White, 261 African American/Black) with cancer who underwent a proctectomy between 2016 and 2020 were included. Both Asians and Whites had significantly higher rates of laparoscopic proctectomy relative to African Americans (38.5%, 33.8% and 28.7%, respectively; p = 0.0001). Asians had the highest rate of robotic proctectomy (38.2%, p = 0.0001). Conversely, Black patients had significantly higher rates of open proctectomy followed by Whites and then Asians (42.1%, 35.4% and 23.4%, respectively; p = 0.0001). In multivariable logistic regression with backward elimination, African Americans were 0.7 times as likely to undergo laparoscopic proctectomy and 1.4 times more likely to undergo open proctectomy than Whites (p = 0.043). Compared with Whites, Asians were 1.8, 1.7 and 1.9 times more likely to undergo minimally invasive, laparoscopic proctectomy and robotic proctectomy, respectively (p = 0.0001, p = 0.001, p = 0.0001). CONCLUSION Asians had the highest rate of laparoscopic and robotic proctectomy, while Blacks had the highest rate of open proctectomy. African Americans were least likely to undergo laparoscopic proctectomy compared with all races. Race is an independent risk factor for access to minimally invasive proctectomy.
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Affiliation(s)
- Yosef Y Nasseri
- Cedars-Sinai Medical Center, Los Angeles, California, USA
- Surgery Group of LA, Los Angeles, California, USA
| | | | - Kimberly Oka
- Surgery Group of LA, Los Angeles, California, USA
| | | | - Abbas Smiley
- Westchester Medical Center Health Network, Valhalla, New York, USA
| | | | - Jason Cohen
- Cedars-Sinai Medical Center, Los Angeles, California, USA
- Surgery Group of LA, Los Angeles, California, USA
| | - Moshe Barnajian
- Cedars-Sinai Medical Center, Los Angeles, California, USA
- Surgery Group of LA, Los Angeles, California, USA
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Irani S, Zebib L, Simons ECG, Andino JJ, Palapattu G, Goh KM. Analyzing the Current State and Visibility of Diversity, Equity, and Inclusion Initiatives at Urology Residency Programs. Urology 2024; 188:24-29. [PMID: 38508531 DOI: 10.1016/j.urology.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/23/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To analyze AUA urology residency program websites to determine visibility of diversity, equity, and inclusion (DEI) initiatives. There is growing interest in DEI initiatives by urology applicants, and in recent years, urology programs have invested in efforts to promote DEI. METHODS All ACGME-accredited urology residency program with a website were assessed. Military programs were excluded. A DEI Score Card was developed using published pillars of DEI, including five domains: departmental inclusion, pipeline growth, departmental education, community engagement, and faculty demographics. Program Doximity rank, address, and surrounding demographics were collected to determine predictors of investing in DEI. RESULTS One hundred forty-one urology residency websites were included for analysis. Only 40.7% of programs referenced DEI on their webpage, and 21.4% offered funded mentorship opportunities. Department education and community engagement were the least popular initiatives. The Western, Northeastern, and North Central sections had the highest DEI total score with wide variation across domains. Mention of DEI was not associated with program's county-level social vulnerability or percent minority but was associated with being a top 50 program (OR=4.0; 95% CI 1.8, 8.9; P = .0007). CONCLUSION Less than half of academic urology programs' websites referenced DEI initiatives. Using a DEI score card, our study shows that investment in DEI varies widely by AUA section, and greater investment is positively correlated with program rank. Our DEI score card serves as a tool that programs can use to assess their current DEI investment, identify areas for improvement, and ensure existing initiatives are visible to applicants.
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Affiliation(s)
- Sarosh Irani
- University of Michigan Medical School, Ann Arbor, MI
| | - Laura Zebib
- University of Michigan Medical School, Ann Arbor, MI
| | | | - Juan J Andino
- University of California Los Angeles, Department of Urology, Los Angeles, CA
| | | | - Keow Mei Goh
- Department of Urology, University of Michigan, Ann Arbor, MI.
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11
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Peterman N, Shivdasani K, Naik A, Dharnipragada R, Harrop J, Vaccaro AR, Arnold PM. Geospatial Evaluation of Disparities in Access to Cervical Spine Fusion in Metropolitan Areas Across the United States. Clin Spine Surg 2024; 37:E208-E215. [PMID: 38158598 DOI: 10.1097/bsd.0000000000001564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Abstract
STUDY DESIGN Retrospective study with epidemiologic analysis of public Medicare data. OBJECTIVE The purpose of this study is to use geospatial analysis to identify disparities in access to cervical spine fusions in metropolitan Medicare populations. SUMMARY OF BACKGROUND DATA Cervical spine fusion is among the most common elective procedures performed by spine surgeons and is the most common surgical intervention for degenerative cervical spine disease. Although some studies have examined demographic and socioeconomic trends in cervical spine fusion, few have attempted to identify where disparities exist and quantify them at a community level. METHODS Center for Medicare and Medicaid Services physician billing and Medicare demographic data sets from 2013 to 2020 were filtered to contain only cervical spine fusion procedures and then combined with US Census socioeconomic data. The Moran Index geospatial clustering algorithm was used to identify statistically significant hotspot and coldspots of cervical spine fusions per 100,000 Medicare members at a county level. Univariate and multivariate analysis was subsequently conducted to identify demographic and socioeconomic factors that are associated with access to care. RESULTS A total of 285,405 cervical spine fusions were analyzed. Hotspots of cervical spine fusion were located in the South, while coldspots were throughout the Northern Midwest, the Northeast, South Florida, and West Coast. The percent of Medicare patients that were Black was the largest negative predictor of cervical spine fusions per 100,000 Medicare members ( β =-0.13, 95% CI: -0.16, -0.10). CONCLUSIONS Barriers to access can have significant impacts on health outcomes, and these impacts can be disproportionately felt by marginalized groups. Accounting for socioeconomic disadvantage and geography, this analysis found the Black race to be a significant negative predictor of access to cervical spine fusions. Future studies are needed to further explore potential socioeconomic barriers that exist in access to specialized surgical care. LEVEL OF EVIDENCE Level III-retrospective.
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Affiliation(s)
- Nicholas Peterman
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign
| | - Krishin Shivdasani
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign
- Department of Orthopaedic Surgery & Rehabilitation, Loyola Medicine, Maywood IL
| | - Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis MN
| | - Rajiv Dharnipragada
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis MN
| | - James Harrop
- Department of Neurosurgery, Thomas Jefferson Hospital
| | - Alexander R Vaccaro
- Department of Orthopedic Surgery, Rothman Orthopedic Institute, Philadelphia PA
| | - Paul M Arnold
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign
- Department of Neurosurgery, Carle Foundation Hospital, Urbana IL
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12
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Qiao WP, Haskins SC, Liu J. Racial and ethnic disparities in regional anesthesia in the United States: A narrative review. J Clin Anesth 2024; 94:111412. [PMID: 38364694 DOI: 10.1016/j.jclinane.2024.111412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Racial and ethnic disparities exist in the delivery of regional anesthesia in the United States. Anesthesiologists have ethical and economic obligations to address existing disparities in regional anesthesia care. OBJECTIVES Current evidence of racial and ethnic disparities in regional anesthesia utilization in adult patients in the United States is presented. Potential contributors and solutions to racial disparities are also discussed. EVIDENCE REVIEW Literature search was performed for studies examining racial and ethnic disparities in utilization of regional anesthesia, including neuraxial anesthesia and/or peripheral nerve blocks. FINDINGS While minoritized patients are generally less likely to receive regional anesthesia than white patients, the pattern of disparities for different racial/ethnic groups and for types of regional anesthetics can be complex and varied. Contributors to racial/ethnic disparities in regional anesthesia span hospital, provider, and patient-level factors. Potential solutions include standardization of regional anesthetic practices via Enhanced Recovery After Surgery (ERAS) pathways, increasing patient education, health literacy, language translation services, and improving diversity and cultural competency in the anesthesiology workforce. CONCLUSION Racial and ethnic disparities in regional anesthesia exist. Contributors and solutions to these disparities are multifaceted. Much work remains within the subspecialty of regional anesthesia to identify and address such disparities.
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Affiliation(s)
- William P Qiao
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, United States of America; Department of Anesthesiology, Weill Cornell Medical College, New York, NY, United States of America.
| | - Stephen C Haskins
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, United States of America; Department of Anesthesiology, Weill Cornell Medical College, New York, NY, United States of America.
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, United States of America; Department of Anesthesiology, Weill Cornell Medical College, New York, NY, United States of America.
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13
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Sakowitz S, Bakhtiyar SS, Mallick S, Porter G, Ali K, Vadlakonda A, Curry J, Benharash P. Persistent Racial Disparities in Morbidity Following Major Elective Operations. Am Surg 2024:31348241257462. [PMID: 38820594 DOI: 10.1177/00031348241257462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Introduction: Despite considerable national attention, racial disparities in surgical outcomes persist. We sought to consider whether race-based inequities in outcomes following major elective surgery have improved in the contemporary era. Methods: All adult hospitalization records for elective coronary artery bypass grafting, abdominal aortic aneurysm repair, colectomy, and hip replacement were tabulated from the 2016-2020 National Inpatient Sample. Patients were stratified by Black or White race. To consider the evolution in outcomes, we included an interaction term between race and year. We designated centers in the top quartile of annual procedural volume as high-volume hospitals (HVH). Results: Of ∼2,838,485 patients, 245,405 (8.6%) were of Black race. Following risk-adjustment, Black race was linked with similar odds of in-hospital mortality, but increased likelihood of major complications (Adjusted Odds Ratio [AOR] 1.41, 95%Confidence Interval [CI] 1.36-1.47). From 2016-2020, overall risk-adjusted rates of major complications declined (patients of White race: 9.2% to 8.4%; patients of Black race 11.8% to 10.8%, both P < .001). Yet, the delta in risk of adverse outcomes between patients of White and Black race did not significantly change. Of the cohort, 158,060 (8.4%) were treated at HVH. Following adjustment, Black race remained associated with greater odds of morbidity (AOR 1.37, CI 1.23-1.52; Ref:White). The race-based difference in risk of complications at HVH did not significantly change from 2016 to 2020. Conclusion: While overall rates of complications following major elective procedures declined from 2016 to 2020, patients of Black race faced persistently greater risk of adverse outcomes. Novel interventions are needed to address persistent racial disparities and ensure acceptable outcomes for all patients.
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Affiliation(s)
- Sara Sakowitz
- CORELAB, Department of Surgery, University of California, Los Angeles, CA, USA
| | - Syed Shahyan Bakhtiyar
- CORELAB, Department of Surgery, University of California, Los Angeles, CA, USA
- Department of Surgery, University of Colorado, Denver, Aurora, CO, USA
| | - Saad Mallick
- CORELAB, Department of Surgery, University of California, Los Angeles, CA, USA
| | - Giselle Porter
- CORELAB, Department of Surgery, University of California, Los Angeles, CA, USA
| | - Konmal Ali
- CORELAB, Department of Surgery, University of California, Los Angeles, CA, USA
| | - Amulya Vadlakonda
- CORELAB, Department of Surgery, University of California, Los Angeles, CA, USA
| | - Joanna Curry
- CORELAB, Department of Surgery, University of California, Los Angeles, CA, USA
| | - Peyman Benharash
- CORELAB, Department of Surgery, University of California, Los Angeles, CA, USA
- Department of Surgery, University of California, Los Angeles, Los Angeles, CA, USA
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14
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Tsumura H, Pan W, Brandon D. Exploring Differences in Intraoperative Medication Use Between African American and Non-Hispanic White Patients During General Anesthesia: Retrospective Observational Cohort Study. Clin Nurs Res 2024:10547738241253652. [PMID: 38767246 DOI: 10.1177/10547738241253652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
This study aimed to explore whether differences exist in anesthesia care providers' use of intraoperative medication between African American and non-Hispanic White patients in adult surgical patients who underwent noncardiothoracic nonobstetric surgeries with general anesthesia. A retrospective observational cohort study used electronic health records between January 1, 2018 and August 31, 2019 at a large academic health system in the southeastern United States. To evaluate the isolated impact of race on intraoperative medication use, inverse probability of treatment weighting using the propensity scores was used to balance the covariates between African American and non-Hispanic White patients. Regression analyses were then performed to evaluate the impact of race on the total dose of opioid analgesia administered, and the use of midazolam, sugammadex, antihypotensive drugs, and antihypertensive drugs. Of the 31,790 patients included in the sample, 58.9% were non-Hispanic Whites and 13.6% were African American patients. After adjusting for significant covariates, African American patients were more likely to receive midazolam premedication (p < .0001; adjusted odds ratio [aOR] = 1.17, 99.9% CI [1.06, 1.30]), and antihypertensive drugs (p = .0002; aOR = 1.15, 99.9% CI [1.02, 1.30]), and less likely to receive antihypotensive drugs (p < .0001; aOR = 0.85, 99.9% CI [0.76, 0.95]) than non-Hispanic White patients. However, we did not find significant differences in the total dose of opioid analgesia administered, or sugammadex. This study identified differences in intraoperative anesthesia care delivery between African American and non-Hispanic White patients; however, future research is needed to understand mechanisms that contribute to these differences and whether these differences are associated with patient outcomes.
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Affiliation(s)
- Hideyo Tsumura
- Duke University School of Nursing, Durham, NC, USA
- Duke University Health System, Durham, NC, USA
| | - Wei Pan
- Duke University School of Nursing, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | - Debra Brandon
- Duke University School of Nursing, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
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15
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Nanda R, Taghlabi KM, Somawardana I, Bhenderu LS, Guerrero JR, Tahanis A, Cruz-Garza JG, Faraji AH. Racial Disparities in Outcomes Following Surgical Fixation of Traumatic Thoracolumbar Fractures: A National Database Analysis. World Neurosurg 2024:S1878-8750(24)00748-4. [PMID: 38710406 DOI: 10.1016/j.wneu.2024.04.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE This study aims to assess race as an independent risk factor for postoperative complications after surgical fixation of traumatic thoracolumbar fractures for African American and Asian American patients compared with White patients. METHODS The 2011-2021 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset was used to identify patients undergoing fusion surgeries for thoracolumbar spine fractures. Patient comorbidity burden was assessed using a modified 5-item frailty index score (mFI-5). Chi-squared and ANOVA tests were used to compare baseline clinical characteristics between groups. Multivariate analysis was performed to compare African American and Asian American patients with White patients controlling for age, BMI, and American Society of Anesthesiologists (ASA) score. RESULTS African American patients experienced longer operative times compared to Asian American and White patients (3.74 ± 1.87 hours vs. 3.04 ± 1.71 hours and 3.48 ± 1.81 hours, P < 0.001). African American and Asian American patients demonstrated higher comorbidity burden with mFI-5>2 compared to White patients (30.7% and 25.6% vs. 19.9%, P < 0.001). African American and Asian American patients had a higher risk of postoperative complications than White patients (22.4% and 20% vs. 19.7%, P < 0.001). African American race was an independent risk factor of postoperative 30-day morbidity (OR 1.19, CI 1.11-1.28, P < 0.001). CONCLUSIONS African American and Asian American patients undergoing thoracolumbar fusion surgeries exhibit disproportionate comorbidity burden, longer LOS, and greater postoperative complications compared with White patients. Furthermore, the African American race was associated with an increased rate of 30-day postoperative complications.
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Affiliation(s)
- Rijul Nanda
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Texas A&M University School of Engineering Medicine, Houston, Texas; Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas.
| | - Khaled M Taghlabi
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas
| | - Isuru Somawardana
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Texas A&M University School of Engineering Medicine, Houston, Texas; Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas
| | - Lokeshwar S Bhenderu
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas
| | - Jaime R Guerrero
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas
| | - Aboud Tahanis
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas
| | - Jesus G Cruz-Garza
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas
| | - Amir H Faraji
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas
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16
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Gautam D, Venkatraman V, Horns J, Yang LZ, Lee HJ, Kassavetis P, Alshaikh J, Moretti P, Shofty B, Rahimpour S. Demographics of focused ultrasound thalamotomy for essential tremor and trends in deep brain stimulation surgery after its introduction in the USA. BMJ Neurol Open 2024; 6:e000582. [PMID: 38618151 PMCID: PMC11015248 DOI: 10.1136/bmjno-2023-000582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/31/2024] [Indexed: 04/16/2024] Open
Abstract
Background Essential tremor (ET) is a movement disorder that affects 4%-5% of adults >65 years. For patients with medically refractory ET, neurosurgical interventions such as deep brain stimulation (DBS) and unilateral MR-guided focused ultrasound thalamotomy (MRgFUS) are available. In this retrospective cohort study, we examined the demographics of patients with ET who have received MRgFUS and evaluated trends in DBS usage in the USA after the introduction of MRgFUS in 2016. Methods We used multiple databases to examine the demographics of patients who received DBS and MRgFUS, and trends in DBS. To assess the demographics, we queried the TriNetX database from 2003 to 2022 to identify patients diagnosed with ET and stratify them by DBS or MRgFUS treatment by using Current Procedural Terminology codes. Patient demographics were reported as frequencies and percentages. To examine the trends in DBS for ET, the yearly frequency of DBS procedures done for ET between 2012 and 2019 was extracted from the National Inpatient Sample (NIS) database, and breakpoint analysis was performed. Additionally, the yearly frequency of MRgFUS procedures for ET was obtained from Insightec Exlabate. Results Most of the patients (88.69%) in the cohort extracted from TriNetX database self-identified as white, followed by black or African American (2.40%) and Asian (0.52%). A higher percentage of black patients received MRgFUS treatment than DBS (4.10% vs 1.88%). According to the NIS database, from 2012 to 2020, 13 525 patients received DBS for ET. Conclusion This study provides an overview of the characteristics of patients who undergo DBS or MRgFUS. We found notable differences in sex and race among patients who underwent each treatment type. Additionally, until at least the beginning of 2020, the number of DBS procedures for ET was not negatively affected after the introduction of MRgFUS.
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Affiliation(s)
- Diwas Gautam
- University of Utah Health, Salt Lake City, Utah, USA
| | | | - Joshua Horns
- Department of Surgery, Surgical Population Analysis Core, University of Utah Health, Salt Lake City, Utah, USA
| | - Lexie Zidanyue Yang
- Department of Biostatistics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hui-Jie Lee
- Department of Biostatistics, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Jumana Alshaikh
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Paolo Moretti
- Department of Neurology, University of Utah Health, Salt Lake City, Utah, USA
| | - Ben Shofty
- Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Shervin Rahimpour
- Department of Neurosurgery, University of Utah Health, Salt Lake City, Utah, USA
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17
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Adjei J, Tang M, Lipa S, Oyekan A, Woods B, Mesfin A, Hogan MV. Addressing the Impact of Race and Ethnicity on Musculoskeletal Spine Care in the United States. J Bone Joint Surg Am 2024; 106:631-638. [PMID: 38386767 DOI: 10.2106/jbjs.22.01155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
➤ Despite being a social construct, race has an impact on outcomes in musculoskeletal spine care.➤ Race is associated with other social determinants of health that may predispose patients to worse outcomes.➤ The musculoskeletal spine literature is limited in its understanding of the causes of race-related outcome trends.➤ Efforts to mitigate race-related disparities in spine care require individual, institutional, and national initiatives.
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Affiliation(s)
- Joshua Adjei
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melissa Tang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shaina Lipa
- Department of Orthopedic Surgery, Brigham and Woman's Hospital, Boston, Massachusetts
| | - Anthony Oyekan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Barrett Woods
- Department of Orthopedic Surgery, Rothman Orthopedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, Medstar Orthopaedic Institute, Georgetown University School of Medicine, Washington, DC
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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18
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Smith B, Smith BP, Hollis RH, Jones BA, Shao C, Katta M, Wood L, Bateman LB, Oates GR, Chu DI. Development of a comprehensive survey to assess key socioecological determinants of health. Surgery 2024; 175:991-999. [PMID: 38158309 PMCID: PMC10947950 DOI: 10.1016/j.surg.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/22/2023] [Accepted: 11/07/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Although disparities in surgical outcomes are well-documented, our understanding of how socioecological factors drive these disparities remains limited. Comprehensive and efficient assessment tools are needed. This study's objective was to develop and assess the acceptability and feasibility of a comprehensive tool evaluating socioecological determinants of health in patients requiring colorectal surgery. METHODS In the first phase, a comprehensive socioecological determinant of health assessment tool was developed. A review of validated socioecological health evaluation instruments was conducted, and a 2-step modified Delphi method addressed the length, clarity, appropriateness, and redundancy of each instrument. A comprehensive tool was then finalized. In the second phase, the tool was tested for acceptability and feasibility in adult patients requiring colorectal surgery using a theory-guided framework at 3 Alabama hospitals. Relationships between survey responses and measures of acceptability and feasibility were evaluated using results from initial pilot tests of the survey. RESULTS In Phase 1, a modified Delphi process led to the development of a comprehensive tool that included 31 socioecological determinants of health (88 questions). Results of acceptability and feasibility were globally positive (>65%) for all domains. Overall, 83% of participants agreed that others would have no trouble completing the survey, 90.4% of respondents reported the survey was not burdensome, 97.6% of patients reported having enough time to complete the survey, and 80.9% agreed the survey was well-integrated into their appointment. CONCLUSION An 88-item assessment tool measuring 31 socioecological determinants of health was developed with high acceptability and feasibility for patients who required colorectal surgery. This work aids in the development of research needed to understand and address surgical disparities.
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Affiliation(s)
- Baker Smith
- University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, Birmingham, AL
| | - Burkely P Smith
- University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, Birmingham, AL
| | - Robert H Hollis
- University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, Birmingham, AL
| | - Bayley A Jones
- University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, Birmingham, AL
| | - Connie Shao
- University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, Birmingham, AL
| | - Meghna Katta
- University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, Birmingham, AL
| | - Lauren Wood
- University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, Birmingham, AL
| | - Lori B Bateman
- Division of Preventive Medicine and O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Gabriela R Oates
- University of Alabama at Birmingham, Department of Pediatrics, Birmingham, AL
| | - Daniel I Chu
- University of Alabama at Birmingham, Department of Surgery, Division of Gastrointestinal Surgery, Birmingham, AL.
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19
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Njoroge MW, Karwoski AS, Gornitsky J, Resnick E, Galaria A, Lopez CD, Boahene KDO, Yang R. Socioeconomic Disparities in Postoperative Outcomes of Osteocutaneous Fibula Free Flaps for Head and Neck Reconstruction. Ann Plast Surg 2024; 92:S167-S171. [PMID: 38556668 DOI: 10.1097/sap.0000000000003869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Osteocutaneous fibula free flaps (FFFs) are a fundamental component of reconstructive surgery in the head and neck region, particularly after traumatic injuries or oncologic resections. Despite their utility, FFFs are associated with various postoperative complications, such as infection, flap failure, and donor site morbidity, impacting up to 54% of cases. This study aimed to investigate the influence of socioeconomic variables, with a particular focus on median household income (MHI), on the incidence of postoperative complications in FFF reconstruction for head and neck cancer. METHODS A retrospective analysis of 80 patients who underwent FFF reconstruction for head and neck cancer at a single center from 2016 to 2022 was conducted. Demographic and patient characteristics, including race, MHI, insurance type, history of radiation therapy, and TNM (tumor, node, metastasis) cancer stage, were evaluated. Logistic regression, controlling for comorbidities, was used to assess the impact of MHI on 30-, 90-, and 180-day postoperative complications. RESULTS The patient population was predominantly male (n = 51, 63.8%) and White (n = 63, 78.8%), with the majority falling within the $55,000 to $100,000 range of MHI (n = 51, 63.8%). Nearly half of the patients had received neoadjuvant radiation treatment (n = 39, 48.75%), and 36.25% (n = 29) presented with osteoradionecrosis. Logistic regression analysis revealed that the $55,000-$100,000 MHI group had significantly lower odds of developing complications in the 0- to 30-day postoperative period when compared with those in the <$55,000 group (odds ratio [OR], 0.440; 95% confidence interval [CI], 0.205-0.943; P = 0.035). This trend persisted in the 31- to 90-day period (OR, 0.136; 95% CI, 0.050-0.368; P < 0.001) and was also observed in the likelihood of flap takeback. In addition, the $100,000-$150,000 group had significantly lower odds of developing complications in the 31- to 90-day period (OR, 0.182; 95% CI, 0.035-0.940; P = 0.042). No significant difference was found in the >$150,000 group. CONCLUSIONS Median household income is a significant determinant and potentially a more influential factor than neoadjuvant radiation in predicting postoperative complications after FFF reconstruction. Disparities in postoperative outcomes based on income highlight the need for substantial health care policy shifts and the development of targeted support strategies for patients with lower MHI.
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Affiliation(s)
- Moreen W Njoroge
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | | | | | | | | | - Christopher D Lopez
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
| | - Kofi D O Boahene
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robin Yang
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine
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20
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Chidiac C, Phan P, Rhee DS, Garcia AV. Access to Laparoscopic Pediatric Surgery: Do Ethnic and Racial Disparities Exist? J Surg Res 2024; 296:265-272. [PMID: 38295714 DOI: 10.1016/j.jss.2023.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/12/2023] [Accepted: 12/30/2023] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Disparate access to laparoscopic surgery may contribute to poorer health outcomes among racial and ethnic minorities, especially among children. We investigated whether racial and ethnic disparities in laparoscopic procedures existed among four common surgical operations in the pediatric population in the United States. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program-Pediatrics, we conducted a retrospective review of pediatric patients, aged less than 18 y old, undergoing appendectomy, fundoplication, cholecystectomy, and colectomy from 2012 to 2021. To compare the surgical approach (laparoscopy or open), a propensity score matching algorithm was used to compare laparoscopic and open procedures between non-Hispanic Black with non-Hispanic White children and Hispanic with non-Hispanic White children. RESULTS 143,205, 9,907, 4,581, and 26,064 children underwent appendectomy, fundoplication, colectomy, and cholecystectomy, respectively. After propensity score matching, non-Hispanic Black children undergoing appendectomy were found to be treated laparoscopically less than non-Hispanic White children (93.5% versus 94.4%, P = 0.007). With fundoplication, Hispanic children were more likely to be treated laparoscopically than White ones (86.7% versus 80.9%, P < 0.0001). There were no statistically significant differences between Black or Hispanic children and White children in rates of laparoscopy for other procedures. CONCLUSIONS Though some racial and ethnic disparities exist with appendectomies and fundoplications, there is limited evidence to indicate that widespread inequities among common laparoscopic procedures exist in the pediatric population.
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Affiliation(s)
- Charbel Chidiac
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul Phan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alejandro V Garcia
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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21
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Tort Saadé PJ, White AA. Sports Medicine Patient Experience: Implicit Bias Mitigation and Communication Strategies. Clin Sports Med 2024; 43:279-291. [PMID: 38383110 DOI: 10.1016/j.csm.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Unconscious bias, also known as implicit bias, is the principal contributor to the perpetuation of discrimination and is a robust determinant of people's decision-making. Unconscious bias occurs despite conscious nonprejudiced intentions and interferes with the actions of the reflective and conscious side. Education and self-awareness about implicit bias and its potentially harmful effects on judgment and behavior may lead individuals to pursue corrective action and follow implicit bias mitigation communication strategies. Team physicians must follow existing communication strategies and guidelines to mitigate unconscious bias and begin an evolution toward nonbiased judgment and decision-making to improve athlete care.
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Affiliation(s)
- Pedro J Tort Saadé
- Surgery Department, Doctors' Center Hospital San Juan, San Juan, Puerto Rico; Universidad Central del Caribe School of Medicine, Bayamon, Puerto Rico.
| | - Augustus A White
- Ellen and Melvin Gordon Distinguished Professor Emeritus of Medical Education and Professor Emeritus of Orthopedic Surgery at Harvard Medical School, Boston, MA, USA
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22
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Munir MM, Lima HA, Endo Y, Moazzam Z, Woldesenbet S, Azap L, Katayama E, Dilhoff M, Cloyd J, Ejaz A, Pawlik TM. Association of Racial and Economic Privilege on Postoperative Outcomes Among Medicare Beneficiaries. J Surg Res 2024; 296:37-46. [PMID: 38215675 DOI: 10.1016/j.jss.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/15/2023] [Accepted: 12/17/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Social determinants of health can play an important role in patient health. Privilege is a right, benefit, advantage, or opportunity that can positively affect all social determinants of health. We sought to assess variations in the prevalence of privilege among patient populations and define the association of privilege on postoperative surgical outcomes. METHODS Medicare beneficiaries who underwent elective coronary artery bypass grafting, abdominal aortic aneurysm repair, total hip arthroplasty, total knee arthroplasty, colectomy, and lung resection were identified. The Index of Concentration of Extremes (ICE), a validated metric of both social spatial polarization and privilege was calculated and merged with county-level data obtained from the American Community Survey. Textbook outcome (TO) was defined as absence of postoperative complications, extended length of stay, 90-day mortality, and 90-day readmission. Multivariable regression analysis was performed to assess the relationship between ICE and TO. RESULTS Among 1,885,889 Medicare beneficiaries who met inclusion criteria, 655,980 (34.8%) individuals resided in areas with the highest privilege (i.e., White, high-income homogeneity), whereas 221,314 (11.7%) individuals resided in areas of the lowest privilege (i.e., Black, low-income homogeneity). The overall incidence of TO was 66.2% (n = 1,247,558). On multivariable regression, residence in the most advantaged neighbourhoods was associated with a lower chance of surgical complications (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.88-0.91), a prolonged length of stay (OR 0.81, 95% CI 0.79-82), 90-day readmission (OR 0.94, 95% CI 0.92-0.95), and 90-day mortality (OR 0.71, 95% CI 0.68-0.74) (all P < 0.001). Residence in the most privileged areas was associated with 19% increased odds of achieving TO (OR 1.19, 95% CI 1.18-1.21), as well as a 6% reduction in Medicare expenditures versus individuals in the least privileged counties (OR 0.94, 95% CI 0.94-0.94) (both P < 0.001). CONCLUSIONS Privilege, based on the ICE joint measure of racial/ethnic and economic spatial concentration, was strongly associated with the likelihood to achieve an "optimal" TO following surgery. As healthcare is a basic human right, privilege should not be associated with disparities in surgical care.
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Affiliation(s)
- Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Lovette Azap
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Erryk Katayama
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Mary Dilhoff
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.
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23
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Singal S, Howell D, Hanna L, Tang SX, Van Meter A, Saito E, Kane JM, Michaels TI. Race-Based Disparities in the Frequency and Duration of Restraint Use in a Psychiatric Inpatient Setting. Psychiatr Serv 2024; 75:308-315. [PMID: 37855100 DOI: 10.1176/appi.ps.20230057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Patients' race and age have each been identified as risk factors for experiencing restraint events during psychiatric hospitalization. Restraint duration is also an important variable in determining disparities in treatment. To the authors' knowledge, no studies to date have examined the effect of the interaction of race and age on restraint use and duration in inpatient psychiatric settings. This retrospective chart review of electronic medical records of patients admitted between 2012 and 2019 sought to examine whether race and age interacted in predicting differences in the use and duration of restraints in a psychiatric inpatient setting. METHODS Logistic and hierarchical regression analyses were conducted on data from a sample of 29,739 adolescent (ages 12-17 years) and adult (ages ≥18 years) inpatients to determine whether the interaction of race and age group (adolescent or adult) significantly predicted a restraint event or differences in restraint duration. RESULTS Black (adjusted OR [AOR]=1.85) and multiracial (AOR=1.36) patients were more likely to experience a restraint event than were their White peers. Black race was also significantly (p=0.001) associated with longer restraint duration. No significant interaction was detected between race and age in predicting restraint events or duration. CONCLUSIONS Although the interaction between race and age did not predict restraint events or duration, the findings indicate racial disparities in the frequency and duration of restraint events among Black and multiracial individuals and may inform efforts to reduce these events.
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Affiliation(s)
- Sonali Singal
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Danielle Howell
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Lauren Hanna
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Sunny X Tang
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Anna Van Meter
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Ema Saito
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - John M Kane
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Timothy I Michaels
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
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24
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Escobar-Domingo MJ, Bustos VP, Kim E, Xun H, Foppiani J, Taylor A, Falcon D, Lin SJ, Lee BT. The impact of race and ethnicity in outpatient breast reconstruction decision-making and postoperative outcomes: A propensity score-matched NSQIP analysis. J Plast Reconstr Aesthet Surg 2024; 91:343-352. [PMID: 38442515 DOI: 10.1016/j.bjps.2024.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/20/2023] [Accepted: 02/04/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Recent literature has established outpatient breast reconstruction (BR) to be a safe alternative to inpatient BR. However, the impact of race and ethnicity on BR patient decision-making and postsurgical outcomes remains unexplored. This study aims to assess the impact of race and ethnicity on outpatient BR timing and postoperative complication rates. METHODS The 2013-2020 ACS-NSQIP database was utilized to identify women undergoing outpatient BR. Propensity score-matched analysis was conducted to generate balanced cohorts based on race and ethnicity. t-tests and Fisher's exact tests were used to assess group differences. Logistic regressions were modeled to evaluate differences in complications between groups. RESULTS A total of 63,526 patients underwent outpatient BR. After propensity score matching, 7664 patients and 3948 patients were included in the race and ethnicity-based analysis, respectively. There were statistically significant differences in the timing of BR patients received across cohorts. NW patients had lower rates of immediate BR (IBR) compared with White patients (47% vs. 53%, p < 0.001), and this also was seen in Hispanic patients (97% vs. 3%, p = 0.018). Subsequently, there were higher rates of delayed BR (DBR) in the NW cohort (55% vs. 45%, p < 0.001) and in the Hispanic cohort (95% vs. 5%, p = 0.018). There were no significant differences in the rates of 30-day postoperative complications across cohorts. CONCLUSIONS Ultimately, our findings suggest that minority patients are more likely to undergo DBR than nonminority patients. However, there were no differences in 30-day postoperative outcomes across race or ethnicity. Future studies to elucidate patients' decision-making process in choosing optimal BR types and timing are necessary to better understand the impact of the observed differences in patient care.
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Affiliation(s)
- Maria J Escobar-Domingo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Valeria P Bustos
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami, Miami, FL, USA
| | - Erin Kim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Helen Xun
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jose Foppiani
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ainsley Taylor
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dominick Falcon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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25
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Alexander T, Burnette CB, Cory H, McHale S, Simone M. The need for more inclusive measurement to advance equity in eating disorders prevention. Eat Disord 2024:1-19. [PMID: 38488765 DOI: 10.1080/10640266.2024.2328460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Eating disorder (ED) research and practice have been shaped by prevailing stereotypes about who EDs are most likely to affect. Subsequently, the field has prioritized the needs and concerns of affluent, cisgender, heterosexual, white girls and women to the exclusion of others, especially people marginalized based on their race, ethnicity, sexual orientation, and/or gender identity. However, EDs exist across diverse groups and actually occur with elevated prevalence in several marginalized groups. Growing research points to differences in the drivers of EDs in such groups (e.g. desire to attain the curvy rather than thin ideal; dietary restraint due to food insecurity rather than weight/shape concerns), yet tools typically used for screening and intervention evaluation do not capture eating pathology driven by such factors. In this commentary, we describe gaps in existing ED assessment tools and argue these gaps likely underestimate EDs among marginalized groups, bias who is invited, participates in, and benefits from ED prevention programs, and obscure potential group differences in the efficacy of such programs. We also discuss the potential of these ramifications to exacerbate inequities in EDs. Finally, we outline recommendations to overcome existing gaps in measurement and, consequently, advance equity in the realm of ED prevention.
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Affiliation(s)
- Tricia Alexander
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - C Blair Burnette
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Hannah Cory
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
- Department of Health Promotion and Community Health, School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, USA
| | - Safiya McHale
- Department of Psychology, College of Liberal Arts and Sciences, University of Colorado Denver, Denver, CO, USA
| | - Melissa Simone
- Department of Psychology, College of Liberal Arts and Sciences, University of Colorado Denver, Denver, CO, USA
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26
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Pfeuti CK, Madsen A, Habermann E, Glasgow A, Occhino JA. Postoperative Complications After Sling Operations for Incontinence: Is Race a Factor? UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:197-204. [PMID: 38484232 DOI: 10.1097/spv.0000000000001451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE Racial and ethnic disparities exist in urogynecologic surgery; however, literature identifying specific disparities after sling operations for stress incontinence are limited. OBJECTIVE The objective of this study was to evaluate racial and ethnic disparities in surgical complications within 30 days of midurethral sling operations. STUDY DESIGN This retrospective cohort study identified women who underwent an isolated midurethral sling operation between 2014 and 2021 using the American College of Surgeons National Surgical Quality Improvement Program database. Women were stratified by racial and ethnic category to assess the primary outcome, 30-day surgical complications, and the secondary outcome, comparison of urinary tract infections (UTIs). RESULTS There were 20,066 patients included. Mean age and body mass index were 53.9 years and 30.8, respectively. More Black or African American women had diabetes and hypertension, and more American Indian or Alaska Native women used tobacco. The only difference in 30-day complications was stroke/cerebrovascular accident, which occurred in only 1 Asian, Native Hawaiian or other Pacific Islander patient (0.1%, P < 0.0001). The most frequent complication was UTI (3.3%). Black or African American women were significantly less likely to have a diagnosis of UTI than non-Hispanic White (P = 0.04), Hispanic White (P = 0.03), and American Indian or Alaska Native women (P = 0.04). CONCLUSIONS Surgical complications within 30 days of sling operations are rare. No clinically significant racial and ethnic differences in serious complications were observed. Urinary tract infection diagnoses were lower among Black or African American women than in non-Hispanic White, Hispanic White, and American Indian or Alaska Native women despite a greater comorbidity burden. No known biologic reason exists to explain lower UTI rates in this population; therefore, this finding may represent a disparity in diagnosis and treatment.
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Affiliation(s)
| | - Annetta Madsen
- Mayo Clinic, Division of Female Pelvic Medicine & Reconstructive Surgery, Rochester, MN
| | | | - Amy Glasgow
- Mayo Clinic, Division of Female Pelvic Medicine & Reconstructive Surgery, Rochester, MN
| | - John A Occhino
- Mayo Clinic, Division of Female Pelvic Medicine & Reconstructive Surgery, Rochester, MN
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27
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Akosman I, Kumar N, Mortenson R, Lans A, De La Garza Ramos R, Eleswarapu A, Yassari R, Fourman MS. Racial Differences in Perioperative Complications, Readmissions, and Mortalities After Elective Spine Surgery in the United States: A Systematic Review Using AI-Assisted Bibliometric Analysis. Global Spine J 2024; 14:750-766. [PMID: 37363960 PMCID: PMC10802512 DOI: 10.1177/21925682231186759] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
STUDY DESIGN Systematic Review and Meta-analysis. OBJECTIVES To evaluate the impact of race on post-operative outcomes and complications following elective spine surgery in the United States. METHODS PUBMED, MEDLINE(R), ERIC, EMBASE, and SCOPUS were searched for studies documenting peri-operative events for White and African American (AA) patients following elective spine surgery. Pooled odds ratios were calculated for each 90-day outcome and meta-analyses were performed for 4 peri-operative events and 7 complication categories. Sub-analyses were performed for each outcome on single institution (SI) studies and works that included <100,000 patients. RESULTS 53 studies (5,589,069 patients, 9.8% AA) were included. Eleven included >100,000 patients. AA patients had increased rates of 90-day readmission (OR 1.33, P = .0001), non-routine discharge (OR 1.71, P = .0001), and mortality (OR 1.66, P = .0003), but not re-operation (OR 1.16, P = .1354). AA patients were more likely to have wound-related complications (OR 1.47, P = .0001) or medical complications (OR 1.35, P = .0006), specifically cardiovascular (OR 1.33, P = .0126), deep vein thrombosis/pulmonary embolism (DVT/PE) (OR 2.22, P = .0188) and genitourinary events (OR 1.17, P = .0343). SI studies could only detect racial differences in re-admissions and non-routine discharges. Studies with <100,000 patients replicated the above findings but found no differences in cardiovascular complications. Disparities in mortality were only detected when all studies were included. CONCLUSIONS AA patients faced a greater risk of morbidity across several distinct categories of peri-operative events. SI studies can be underpowered to detect more granular complication types (genitourinary, DVT/PE). Rare events, such as mortality, require larger sample sizes to identify significant racial disparities.
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Affiliation(s)
| | - Neerav Kumar
- Weill Cornell School of Medicine, New York, NY, USA
| | | | - Amanda Lans
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Ananth Eleswarapu
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Reza Yassari
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Mitchell S. Fourman
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA
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28
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Malapati SH, Edelen MO, Kaur MN, Zeng C, Ortega G, McCleary NJ, Hubbell H, Meyers P, Bryant AS, Sisodia RC, Pusic AL. Social Determinants of Health Needs and Health-related Quality of Life Among Surgical Patients: A Retrospective Analysis of 8512 Patients. Ann Surg 2024; 279:443-449. [PMID: 37800351 DOI: 10.1097/sla.0000000000006117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To assess associations between social determinants of health (SDOH) needs and health-related quality of life (HRQOL) among surgical patients. BACKGROUND Despite the profound impact of SDOH on health outcomes, studies examining the effect of SDOH needs on HRQOL among surgical patients are limited. METHODS A retrospective study was conducted using responses from the SDOH needs assessment and the Patient-Reported Outcomes Measurement Information Systems Global Health instrument of adults seen in surgical clinics at a single institution. Patient characteristics including socioeconomic status (insurance type, education level, and employment status) were extracted. Stepwise multivariable logistic regression analyses were performed to identify independent predictors of global health scores. RESULTS A total of 8512 surgical patients (mean age: 55.6±15.8 years) were included. 25.2% of patients reported one or more SDOH needs. The likelihood of reporting at least one SDOH need varied by patient characteristics and socioeconomic status variables. In fully adjusted regression models, food insecurity [odds ratio (OR), 1.53; 95% CI, 1.38-1.70 and OR, 1.49; 95% CI, 1.22-1.81, respectively], housing instability (OR, 1.27; 95% CI, 1.12-1.43 and OR, 1.39; 95% CI, 1.13-1.70, respectively) lack of transportation (OR, 1.46; 95% CI, 1.27-1.68 and OR, 1.25; 95% CI, 1.00-1.57, respectively), and unmet medication needs (OR, 1.31; 95% CI, 1.13-1.52 and OR, 1.61; 95% CI, 1.28-2.03, respectively) were independent predictors of poor physical and mental health. CONCLUSIONS SDOH needs are independent predictors of poor patient-reported physical and mental health among surgical patients. Assessing and addressing SDOH needs should be prioritized in health care settings and by policymakers to improve HRQOL.
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Affiliation(s)
- Sri Harshini Malapati
- The Patient-Reported Outcome, Value and Experience Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Maria O Edelen
- The Patient-Reported Outcome, Value and Experience Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Manraj N Kaur
- The Patient-Reported Outcome, Value and Experience Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Chengbo Zeng
- The Patient-Reported Outcome, Value and Experience Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Gezzer Ortega
- The Patient-Reported Outcome, Value and Experience Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nadine J McCleary
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Harrison Hubbell
- Office of the Chief Medical Officer, Mass General Brigham, Boston, MA
| | - Peter Meyers
- Office of the Chief Medical Officer, Mass General Brigham, Boston, MA
| | - Allison S Bryant
- Office of the Chief Medical Officer, Mass General Brigham, Boston, MA
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Rachel C Sisodia
- Office of the Chief Medical Officer, Mass General Brigham, Boston, MA
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Andrea L Pusic
- The Patient-Reported Outcome, Value and Experience Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Farivar D, Peterman NJ, Narendran N, Illingworth KD, Nuckols TK, Bonda D, Skaggs DL. Geographic access to pediatric neurosurgeons in the USA: an analysis of sociodemographic factors. Childs Nerv Syst 2024; 40:905-912. [PMID: 37794171 PMCID: PMC10891277 DOI: 10.1007/s00381-023-06172-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE Geographic access to physicians has been shown to be unevenly distributed in the USA, with those in closer proximity having superior outcomes. The purpose of this study was to describe how geographic access to pediatric neurosurgeons varies across socioeconomic and demographic factors. METHODS Actively practicing neurosurgeons were identified by matching several registries and membership logs. This data was used to find their primary practice locations and the distance the average person in a county must travel to visit a surgeon. Counties were categorized into "surgeon deserts" and "surgeon clusters," which were counties where providers were significantly further or closer to its residents, respectively, compared to the national average. These groups were also compared for differences in population characteristics using data obtained from the 2020 American Community Survey. RESULTS A total of 439 pediatric neurosurgeons were identified. The average person in a surgeon desert and cluster was found to be 189.2 ± 78.1 miles and 39.7 ± 19.6 miles away from the nearest pediatric neurosurgeon, respectively. Multivariate analyses showed that higher Rural-Urban Continuum (RUC) codes (p < 0.001), and higher percentages of American Indian (p < 0.001) and Hispanic (p < 0.001) residents were independently associated with counties where the average person traveled significantly further to surgeons. CONCLUSION Patients residing in counties with greater RUC codes and higher percentages of American Indian and Hispanic residents on average need to travel significantly greater distances to access pediatric neurosurgeons.
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Affiliation(s)
- Daniel Farivar
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nicholas J Peterman
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nakul Narendran
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Kenneth D Illingworth
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Teryl K Nuckols
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Bonda
- Department of Neurological Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - David L Skaggs
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Borja AJ, Karsalia R, Chauhan D, Gallagher RS, Malhotra EG, Punchak MA, Na J, McClintock SD, Marcotte PJ, Yoon JW, Ali ZS, Malhotra NR. Association Between Race and Short-Term Outcomes Across 3988 Consecutive Single-Level Spinal Fusions. Neurosurgery 2024:00006123-990000000-01046. [PMID: 38334372 DOI: 10.1227/neu.0000000000002860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/09/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Race has implications for access to medical care. However, the impact of race, after access to care has been attained, remains poorly understood. The objective of this study was to isolate the relationship between race and short-term outcomes across patients undergoing a single, common neurosurgical procedure. METHODS In this retrospective cohort study, 3988 consecutive patients undergoing single-level, posterior-only open lumbar fusion at a single, multihospital, academic medical center were enrolled over a 6-year period. Among them, 3406 patients self-identified as White, and 582 patients self-identified as Black. Outcome disparities between all White patients vs all Black patients were estimated using logistic regression. Subsequently, coarsened exact matching controlled for outcome-mitigating factors; White and Black patients were exact-matched 1:1 on key demographic and health characteristics (matched n = 1018). Primary outcomes included 30-day and 90-day hospital readmissions, emergency department (ED) visits, reoperations, mortality, discharge disposition, and intraoperative complication. RESULTS Before matching, Black patients experienced increased rate of nonhome discharge, readmissions, ED visits, and reoperations (all P < .001). After exact matching, Black patients were less likely to be discharged to home (odds ratio [OR] 2.68, P < .001) and had higher risk of 30-day and 90-day readmissions (OR 2.24, P < .001; OR 1.91, P < .001; respectively) and ED visits (OR 1.79, P = .017; OR 2.09, P < .001). Black patients did not experience greater risk of intraoperative complication (unintentional durotomy). CONCLUSION Between otherwise homogenous spinal fusion cohorts, Black patients experienced unfavorable short-term outcomes. These disparities were not explained by differences in intraoperative complications. Further investigation must characterize and mitigate institutional and societal factors that contribute to outcome disparities.
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Affiliation(s)
- Austin J Borja
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ritesh Karsalia
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan S Gallagher
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emelia G Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria A Punchak
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jianbo Na
- McKenna EpiLog Fellowship in Population Health at the Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott D McClintock
- Department of Mathematics, The West Chester Statistical Institute, West Chester University, West Chester, Pennsylvania, USA
| | - Paul J Marcotte
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zarina S Ali
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- McKenna EpiLog Fellowship in Population Health at the Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Das RK, Galdyn IA, Perdikis G, Drolet BC, Terhune KP. National patterns in the use of International Statistical Classification of Diseases and Health Related Problems, tenth revision Z codes in ambulatory surgery from 2016 to 2019. Am J Surg 2024; 228:54-61. [PMID: 37407393 DOI: 10.1016/j.amjsurg.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/23/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND In the tenth revision of the International Statistical Classification of Disease and Health Related Problems (ICD-10), Z codes were added to improve documentation and understanding of health-related social needs. We estimated national Z code use in the ambulatory surgery setting from 2016 to 2019. METHODS Using the Nationwide Ambulatory Surgery Sample (NASS), we identified encounters for ambulatory surgery with an ICD-10 code between Z55.0 and Z65.9. Data were stratified by Z code domains from the Centers for Medicare and Medicaid Services (CMS). RESULTS This analysis of 41,827 ambulatory surgery encounters with documented Z codes found that the most documented determinants of health related to multiparity or unwanted pregnancy, homelessness, and incarceration. There was a 16.1% increase in the use of Z codes from 2016 to 2019. CONCLUSION Rates of Z code use in the ambulatory surgery setting are increasing with current documentation serving as a specific but not sensitive measure of socioeconomic need.
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Affiliation(s)
- Rishub K Das
- Vanderbilt University School of Medicine, Nashville, TN, United States.
| | - Izabela A Galdyn
- Vanderbilt University School of Medicine, Department of Plastic Surgery, Nashville, TN, United States
| | - Galen Perdikis
- Vanderbilt University School of Medicine, Department of Plastic Surgery, Nashville, TN, United States
| | - Brian C Drolet
- Vanderbilt University School of Medicine, Department of Plastic Surgery, Nashville, TN, United States
| | - Kyla P Terhune
- Vanderbilt University School of Medicine, Department of Surgery, Nashville, TN, United States
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Moazzam Z, Woldesenbet S, Munir MM, Lima HA, Alaimo L, Endo Y, Cloyd J, Dillhoff M, Ejaz A, Pawlik TM. Mediators of racial disparities in postoperative outcomes among patients undergoing complex surgery. Am J Surg 2024; 228:165-172. [PMID: 37743217 DOI: 10.1016/j.amjsurg.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/07/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND This study sought to quantify the direct and indirect effects of race on postoperative outcomes after complex surgery. METHODS Medicare patients who underwent abdominal aortic aneurysm (AAA) repair, coronary artery bypass grafting (CABG), lung resection or colectomy were identified (2014-2018). Generalized structural equation modelling was utilized to quantify the direct and indirect effects of race on Textbook outcome (TO). RESULTS Among 930,033 patients, 46.8% of patients achieved a TO, with Black patients less likely to achieve a TO (referent: White; Black: OR 0.72, 95% CI 0.70-0.73). Notably, 32.3% of the disparities in TO were attributable to race itself, while 67.7% was explained by other factors. Specifically, residential segregation accounted for 39.4% of the lower TO rates among Black patients, while 21.0% was attributable to a high comorbidity burden. CONCLUSIONS These data highlight the need to target structural racism as a policy priority to promote a more equitable healthcare system.
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Affiliation(s)
- Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Laura Alaimo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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Ikram M, Shen C, Pameijer CR. Racial and Socioeconomic Differences and Surgical Outcomes in Pancreaticoduodenectomy Patients: A Systematic Review of High- Versus Low-Volume Hospitals in the United States. Am Surg 2024; 90:292-302. [PMID: 37941362 DOI: 10.1177/00031348231211040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) is associated with better outcomes in high-volume hospitals. However, it is unknown whether and to what extent the improved performance of high-volume hospitals may be associated with racial and socioeconomic factors, which have been shown to impact operative and postoperative outcomes in major surgeries. This review aims to identify the differences in racial and socioeconomic characteristics of patients who underwent PD surgery in high- and low-volume hospitals. METHODS PubMed, Cochrane, and Web of Science were systematically searched between May 1, 2023 and May 7, 2023 without any time restriction on publication date. Studies that were conducted in the United States and had a direct comparison between high- and low-volume hospitals were included. RESULTS A total of 30 observational studies were included. When racial proportions were compared by hospital volume, thirteen studies reported that compared to high-volume hospitals, a higher percentage of racial minorities underwent PD in low-volume hospitals. Disparities in traveling distance, education levels, and median income at baseline between high- and low-volume hospitals were reported by four, three, and two studies, respectively. CONCLUSION A racial difference at baseline between high- and low-volume hospitals was observed. Socioeconomic factors were less frequently included in existing literature. Future studies are needed to understand the socioeconomic differences between patients receiving PD surgery in high- and low-volume hospitals.
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Affiliation(s)
- Mohammad Ikram
- Department of Surgery, Division of Outcomes Research and Quality, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Chan Shen
- Department of Surgery, Division of Outcomes Research and Quality, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Department of Public Health Sciences, Division of Health Services and Behavioral Research, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Colette R Pameijer
- Department of Surgery, Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Abella M, Hayashi J, Martinez B, Inouye M, Rosander A, Kornblith L, Elkbuli A. A National Analysis of Racial and Sex Disparities Among Interhospital Transfers for Emergency General Surgery Patients and Associated Outcomes. J Surg Res 2024; 294:228-239. [PMID: 37922643 DOI: 10.1016/j.jss.2023.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/20/2023] [Accepted: 09/04/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Studies focusing on Emergency General Surgery (EGS) and Interhospital Transfer (IHT) and the association of race and sex and morbidity and mortality are yet to be conducted. We aim to investigate the association of race and sex and outcomes among IHT patients who underwent emergency general surgery. METHODS A retrospective review of adult patients who were transferred prior to EGS procedures using the National Surgery Quality Improvement Project from 2014 to 2020. Multivariable logistic regression models were used to compare outcomes (readmission, major and minor postoperative complications, and reoperation) between interhospital transfer and direct admit patients and to investigate the association of race and sex for adverse outcomes for all EGS procedures. A secondary analysis was performed for each individual EGS procedure. RESULTS Compared to patients transferred directly from home, IHT patients (n = 28,517) had higher odds of readmission [odds ratio (OR): 1.004, 95% confidence interval (CI) (1.002-1.006), P < 0.001], major complication [adjusted OR: 1.119, 95% CI (1.117-1.121), P < 0.001), minor complication [OR: 1.078, 95% CI (1.075-1.080), P < 0.001], and reoperation [OR: 1.014, 95% CI (1.013-1.015), P < 0.001]. In all EGS procedures, Black patients had greater odds of minor complication [OR 1.041, 95% CI (1.023-1.060), P < 0.001], Native Hawaiian and Pacific Islander patients had greater odds of readmission [OR 1.081, 95% CI (1.008-1.160), P = 0.030], while Asian and Hispanic patients had lower odds of adverse outcome, and female patients had greater odds of minor complication [OR 1.017, 95% CI (1.008-1.027), P < 0.001]. CONCLUSIONS Procedure-specific racial and sex-related disparities exist in emergency general surgery patients who underwent interhospital transfer. Specific interventions should be implemented to address these disparities to improve the safety of emergency procedures.
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Affiliation(s)
| | | | - Brian Martinez
- Dr Kiran C. Patel College of Allopathic Medicine, NOVA Southeastern University, Fort Lauderdale, Florida
| | | | - Abigail Rosander
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona
| | - Lucy Kornblith
- Division of Trauma and Surgical Critical Care, Department of Surgery, Zuckerberg Hospital and Trauma Center, San Francisco, California
| | - Adel Elkbuli
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
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Ardebol J, Kiliç AĪ, Pak T, Menendez ME, Denard PJ. Greater Socioeconomic Disadvantage as Measured by the Area Deprivation Index Is Associated With Failure of Healing Following Arthroscopic Repair of Massive Rotator Cuff Tears but Not With Clinical Outcomes. Arthroscopy 2024; 40:287-293. [PMID: 37774937 DOI: 10.1016/j.arthro.2023.08.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE To analyze the relationship between Area Deprivation Index (ADI) and preoperative status and short-term postoperative clinical outcomes among patients who underwent arthroscopic rotator cuff repair (ARCR) of massive rotator cuff tears (MRCTs). METHODS A retrospective review was conducted on prospectively maintained data on patients who underwent ARCR of MRCTs defined as tear size ≥5 cm or complete tear of at least 2 tendons, with a minimum 2-year follow-up and a valid home address between January 2015 and December 2018. Each patient's home address was mapped to the ADI to determine neighborhood disadvantage. This composite index is composed of 17 census-based indicators, including income, education, employment, and housing quality to quantify the level of socioeconomic deprivation. Ratings were recorded and categorized based on the sample's percentile. Patients were then divided into 2 groups: upper quartile (ie, most disadvantaged [≥75th percentile]) and lower 3 quartiles (ie, least disadvantaged [<75th percentile]). Bivariate analysis was performed to associate ADI with patient-reported outcomes (PROs) and range of motion pre- and postoperatively, as well as complications, healing rate, satisfaction, and return to work. Patients reaching or exceeding the minimal clinically important difference for visual analog scale (VAS), American Shoulder and Elbow Surgeons, Veterans Rand 12-Item questionnaire, and subjective shoulder value were recorded for both cohorts. RESULTS Ninety-nine patients were eligible for study analysis. Preoperative PROs and range of motion were similar, except for a greater VAS for pain (6.3 vs 4.3; P < .01) and lower American Shoulder and Elbow Surgeons score (32.2 vs 45.1; P = .01) in the most disadvantaged group. Both groups showed similar postoperative PROs scores, but greater VAS improvement was seen in the upper quartile group (Δ 4.2 vs Δ 3.0; P = .04). In contrast, only the least-disadvantaged group significantly improved in internal rotation (P = .01) and forward flexion (18°; P < .01) from baseline. Although satisfaction, complications, and return to work were comparable (P > .05), failure of healing occurred more frequently in the most disadvantaged group (21% vs 6%; P = .03). CONCLUSIONS Patients with MRCTs residing in the most disadvantaged neighborhoods as measured by the ADI have more pain and functional limitations before undergoing ARCR but demonstrate similar postoperative functional improvements to patients from other socioeconomic backgrounds. Failure of healing of MRCTs may be more common in disadvantaged groups. Furthermore, both groups reported similar rates of clinically important functional improvement. LEVEL OF EVIDENCE Level III, retrospective cohort comparison.
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Affiliation(s)
| | - Ali Īhsan Kiliç
- Oregon Shoulder Institute, Medford, Oregon, U.S.A.; Izmir Bakircay University, Izmir, Turkey
| | - Theresa Pak
- Oregon Shoulder Institute, Medford, Oregon, U.S.A
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Amen TB, Akosman I, Subramanian T, Johnson MA, Rudisill SS, Song J, Maayan O, Barber LA, Lovecchio FC, Qureshi S. Postoperative racial disparities following spine surgery are less pronounced in the outpatient setting. Spine J 2024:S1529-9430(24)00032-9. [PMID: 38301902 DOI: 10.1016/j.spinee.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND CONTEXT Racial disparities in spine surgery have been thoroughly documented in the inpatient (IP) setting. However, despite an increasing proportion of procedures being performed as same-day surgeries, whether similar differences have developed in the outpatient (OP) setting remains to be elucidated. PURPOSE This study aimed to investigate racial differences in postoperative outcomes between Black and White patients following OP and IP lumbar and cervical spine surgery. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Patients who underwent IP or OP microdiscectomy, laminectomy, anterior cervical discectomy and fusion (ACDF), or cervical disc replacement (CDR) between 2017 and 2021. OUTCOME MEASURES Thirty-day rates of serious and minor adverse events, readmission, reoperation, non-home discharge, and mortality. METHODS A retrospective review of patients who underwent IP or OP microdiscectomy, laminectomy, anterior cervical discectomy and fusion (ACDF), or cervical disc replacement (CDR) between 2017 and 2021 was conducted using the National Surgical Quality Improvement Program (NSQIP) database. Disparities between Black and White patients in (1) adverse event rates, (2) readmission rates, (3) reoperation rates, (4) non-home discharge rates, (5) mortality rates, (6) operative times, and (7) hospital LOS between Black and White patients were measured and compared between IP and OP surgical settings. Multivariable logistic regression analyses were used to adjust for potential effects of baseline demographic and clinical differences. RESULTS Of 81,696 total surgeries, 49,351 (60.4%) were performed as IP and 32,345 (39.6%) were performed as OP procedures. White patients accounted for a greater proportion of IP (88.2% vs. 11.8%) and OP (92.7% vs. 7.3%) procedures than Black patients. Following IP surgery, Black patients experienced greater odds of serious (OR 1.214, 95% CI 1.077-1.370, p=.002) and minor adverse events (OR 1.377, 95% CI 1.113-1.705, p=.003), readmission (OR 1.284, 95% CI 1.130-1.459, p<.001), reoperation (OR 1.194, 95% CI 1.013-1.407, p=.035), and non-home discharge (OR 2.304, 95% CI 2.101-2.528, p<.001) after baseline adjustment. Disparities were less prominent in the OP setting, as Black patients exhibited greater odds of readmission (OR 1.341, 95% CI 1.036-1.735, p=0.026) but were no more likely than White patients to experience adverse events, reoperation, individual complications, non-home discharge, or death (p>.050 for all). CONCLUSIONS Racial inequality in postoperative complications following spine surgery is evident, however disparities in complication rates are relatively less following OP compared to IP procedures. Further work may be beneficial in elucidating the causes of these differences to better understand and mitigate overall racial disparities within the inpatient setting. These decreased differences may also provide promising indication that progress towards reducing inequality is possible as spine care transitions to the OP setting.
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Affiliation(s)
- Troy B Amen
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Izzet Akosman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Tejas Subramanian
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Mitchell A Johnson
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Samuel S Rudisill
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Junho Song
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Omri Maayan
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Lauren A Barber
- Visiting Fellow at St. George and Sutherland Clinical School, University of New South Wales Medicine, Sydney, NSW 2052, Australia
| | | | - Sheeraz Qureshi
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Lin JC, Greenberg PB. Equity, access, and carbon cost-effectiveness of bilateral cataract surgery. Lancet 2024; 403:353. [PMID: 38280775 DOI: 10.1016/s0140-6736(23)01922-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/08/2023] [Indexed: 01/29/2024]
Affiliation(s)
- John C Lin
- Division of Ophthalmology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Paul B Greenberg
- Division of Ophthalmology, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA; Section of Ophthalmology, Providence VA Medical Center, Providence, RI, USA.
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West E, Jackson L, Greene H, Lucas DJ, Gadbois KD, Choi PM. Race Does Not Affect Rates of Surgical Complications at Military Treatment Facility. Mil Med 2024:usad502. [PMID: 38241780 DOI: 10.1093/milmed/usad502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/02/2023] [Accepted: 12/19/2023] [Indexed: 01/21/2024] Open
Abstract
INTRODUCTION Racial minorities have been found to have worse health care outcomes, including perioperative adverse events. We hypothesized that these racial disparities may be mitigated in a military treatment facility, where all patients have a military service connection and are universally insured. MATERIALS AND METHODS This is a single institution retrospective review of American College of Surgeons National Surgical Quality Improvement Program data for all procedures collected from 2017 to 2020. The primary outcome analyzed was risk-adjusted 30-day postoperative complications compared by race. RESULTS There were 6,941 patients included. The overall surgical complication rate was 6.9%. The complication rate was 7.3% for White patients, 6.5% for Black patients, 12.6% for Asian patients, and 3.4% for other races. However, after performing patient and procedure level risk adjustment using multivariable logistic regression, race was not independently associated with surgical complications. CONCLUSIONS Risk-adjusted surgical complication rates do not vary by race at this military treatment facility. This suggests that postoperative racial disparities may be mitigated within a universal health care system.
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Affiliation(s)
- Erin West
- Department of General Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Laurinda Jackson
- Department of General Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Howard Greene
- Clinical Investigation Department, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Donald J Lucas
- Division of Pediatric Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Kyle D Gadbois
- Department of General Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Pamela M Choi
- Division of Pediatric Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
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Elvir-Lazo OL, Yoshihara M, White PF, Yumul R. Impact of Adverse Childhood Experiences on Health-Related Outcomes in Adults: Potential Implications for Perioperative Anesthetic Management. Anesth Analg 2024; 138:210-215. [PMID: 38100805 DOI: 10.1213/ane.0000000000006486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Affiliation(s)
| | - Melanie Yoshihara
- California Northstate University, College of Medicine, Elk Grove, California
| | - Paul F White
- From the Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California
- White Mountain Institute, The Sea Ranch, California
| | - Roya Yumul
- From the Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California
- David Geffen School of Medicine, UCLA, Los Angeles, California
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Abstract
BACKGROUND The purpose of this study was to evaluate the influence of socioeconomic factors on access to congenital hand surgery care, hospital admission charges, and analyze these geographic trends across regions of the country. METHODS Retrospective cohort study was conducted of congenital hand surgery performed in the United States from 2010 through 2020 using the Pediatric Health Information System. Multivariate regression was used to analyze the impact of socioeconomic factors. RESULTS During the study interval, 5531 pediatric patients underwent corrective surgery for congenital hand differences, including syndactyly repair (n = 2439), polydactyly repair (n = 2826), and pollicization (n = 266). Patients underwent surgery at significantly earlier age when treated at above-median case volume hospitals (P < .001). Patients with above-median income (P < .001), non-white race (P < .001), commercial insurance (P < .001), living in an urban community (P < .001), and not living in an underserved area (P < .001) were more likely to be treated at high-volume hospitals. Nearly half of patients chose to seek care at a distant hospital rather than the one locally available (49.5%, n = 1172). Of those choosing a distant hospital, most patients chose a higher-volume facility (80.9%, n = 948 of 1172). On multivariate regression, white patients were significantly more likely to choose a more distant, higher-volume hospital (P < .001). CONCLUSIONS Socioeconomic and geographic factors significantly contribute to disparate access to congenital hand surgery across the country. Patients with higher socioeconomic status are more likely to be treated at high-volume hospitals. Treatment at hospitals with higher case volume is associated with earlier age at surgery and decreased hospital admission charges.
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Hentati F, Kim J, Hoying D, D'Anza B, Rodriguez K. Race and Area of Deprivation Index Predict Outcomes of Endoscopic Sinus Surgery for Chronic Sinusitis. Am J Rhinol Allergy 2024; 38:6-13. [PMID: 37796754 DOI: 10.1177/19458924231204129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
OBJECTIVE The purpose of this study is to characterize the presentation, outcomes, and barriers to care for White and non-White patients undergoing endoscopic sinus surgery (ESS). BACKGROUND ESS is often successful in providing long-term relief for patients suffering from chronic rhinosinusitis (CRS). Literature that uses robust measures of socioeconomic status (SES) and barriers to care to assess ESS outcomes is limited. METHODS A retrospective matched cohort study of patients who underwent ESS for CRS between 1/1/2015 and 6/1/2021 at a single tertiary care academic center was conducted. White and non-White patients were matched 1-to-1 by sex and age (± 5 years). SES was evaluated using the area of deprivation index (ADI). RESULTS Of the 298 patients included in the study, 149 are White and 149 are non-White, 111 (37.2%) have CRS with nasal polyposis (CRSwNP), 141 (47.3%) had allergic rhinitis, 90 (30.2%) had asthma and 22 (7.4%) required revision ESS. Non-White patients were 3.62 times more likely to present with CRSwNP (95% confidence interval [CI] 2.2-5.96) and had 2.87 times increased odds for requiring revision ESS than age and sex-matched White patients (95% CI 1.090-7.545). The median ADI for non-White (6.00) patients was higher than for White patients (3.00) (P < .001) and 21.5% more non-White patients presented with Medicaid (P < .001). CONCLUSION Non-White patients undergoing ESS for CRS are more likely to present from areas with fewer resources and be underinsured. Using robust measures of SES, such as ADI, may allow for care to be tailored to patients with barriers to care.
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Affiliation(s)
- Firas Hentati
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jaehee Kim
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David Hoying
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Brian D'Anza
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kenneth Rodriguez
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Reed WT, Jiang R, Ohnuma T, Kahmke RR, Pyati S, Krishnamoorthy V, Raghunathan K, Osazuwa-Peters N. Malnutrition and Adverse Outcomes After Surgery for Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2024; 150:14-21. [PMID: 37883116 PMCID: PMC10603580 DOI: 10.1001/jamaoto.2023.3486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/10/2023] [Indexed: 10/27/2023]
Abstract
Importance Patients with head and neck cancer (HNC) have an increased risk of malnutrition, partly due to disease location and treatment sequelae. Although malnutrition is associated with adverse outcomes, there is little data on the extent of outcomes and the sociodemographic factors associated with malnutrition in patients with HNC. Objectives To investigate the association of race, ethnicity, and payer type with perioperative malnutrition in patients undergoing HNC surgery and how malnutrition affects clinical outcomes. Design, Setting, and Participants This retrospective cohort study used data from the Premier Healthcare Database to assess adult patients who had undergone HNC surgery from January 2008 to June 2020 at 482 hospitals across the US. Diagnosis and procedure codes were used to identify a subset of patients with perioperative malnutrition. Patient characteristics, payer types, and hospital outcomes were then compared to find associations among race, ethnicity, payer type, malnutrition, and clinical outcomes using multivariable logistic regression models. Analyses were performed from August 2022 to January 2023. Exposures Race, ethnicity, and payer type for primary outcome, and perioperative malnutrition status, race, ethnicity, and payer type for secondary outcomes. Main Outcomes and Measures Perioperative malnutrition status. Secondary outcomes were discharge to home after surgery, hospital length of stay (LOS), total cost, and postoperative pulmonary complications (PPCs). Results The study population comprised 13 895 adult patients who had undergone HNC surgery during the study period; they had a mean (SD) age of 63.4 (12.1) years; 9425 male (67.8%) patients; 968 Black (7.0%), 10 698 White (77.0%), and 2229 (16.0%) individuals of other races; and 887 Hispanic (6.4%) and 13 008 non-Hispanic (93.6%) individuals. Among the total sample, there were 3136 patients (22.6%) diagnosed with perioperative malnutrition. Compared with White patients and patients with private health insurance, the odds of malnutrition were higher for non-Hispanic Black patients (adjusted odds ratio [aOR], 1.31; 95% CI, 1.11-1.56), Medicaid-insured patients (aOR, 1.68; 95% CI, 1.46-1.95), and Medicare-insured patients (aOR, 1.24; 95% CI, 1.10-1.73). Black patients and patients insured by Medicaid had increased LOS, costs, and PPCs, and lower rates of discharge to home. Malnutrition was independently associated with increased LOS (β, 5.20 additional days; 95% CI, 4.83-5.64), higher costs (β, $15 722 more cost; 95% CI, $14 301-$17 143), increased odds of PPCs (aOR, 2.04; 95% CI, 1.83-2.23), and lower odds of discharge to home (aOR, 0.34; 95% CI, 0.31-0.38). No independent association between malnutrition and mortality was observed. Conclusions and Relevance This retrospective cohort study found that 1 in 5 patients undergoing HNC surgery were malnourished. Malnourishment disproportionately affected Black patients and patients with Medicaid, and contributed to longer hospital stays, higher costs, and more postoperative complications.
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Affiliation(s)
- William T. Reed
- Department of Head and Neck Surgery & Communication Sciences, Duke University Health System, Durham, North Carolina
| | - Rong Jiang
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Tetsu Ohnuma
- Critical Care and Perioperative Population Health Research Unit, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Russel R. Kahmke
- Department of Head and Neck Surgery & Communication Sciences, Duke University Health System, Durham, North Carolina
| | - Shreyas Pyati
- Stony Brook University School of Medicine, Stony Brook, New York
| | - Vijay Krishnamoorthy
- Critical Care and Perioperative Population Health Research Unit, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Karthik Raghunathan
- Critical Care and Perioperative Population Health Research Unit, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University Health System, Durham, North Carolina
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
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Mergler BD, Toles AO, Alexander A, Mosquera DC, Lane-Fall MB, Ejiogu NI. Racial and Ethnic Patient Care Disparities in Anesthesiology: History, Current State, and a Way Forward. Anesth Analg 2023:00000539-990000000-00689. [PMID: 38153872 DOI: 10.1213/ane.0000000000006716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Disparities in patient care and outcomes are well-documented in medicine but have received comparatively less attention in anesthesiology. Those disparities linked to racial and ethnic identity are pervasive, with compelling evidence in operative anesthesiology, obstetric anesthesiology, pain medicine, and critical care. This narrative review presents an overview of disparities in perioperative patient care that is grounded in historical context followed by potential solutions for mitigating disparities and inequities.
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Affiliation(s)
- Blake D Mergler
- From the Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Allyn O Toles
- From the Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anthony Alexander
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Diana C Mosquera
- Department of Anesthesiology, Albany Medical Center, Albany, New York
| | - Meghan B Lane-Fall
- From the Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nwadiogo I Ejiogu
- From the Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Akinyemi OA, Weldeslase TA, Fasokun M, Griffiths Y, Andine T, Odusanya E, Williams M, Hughes K, Cornwell E, Fullum T. The impact of the affordable care act on access to bariatric surgery in Maryland. Am J Surg 2023:S0002-9610(23)00667-0. [PMID: 38171943 DOI: 10.1016/j.amjsurg.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION This study aims to investigate the influence of the Affordable Care Act (ACA) on the utilization of Roux-en-Y gastric bypass (RYGB) procedures in Maryland. METHODS Using the Maryland State Inpatient Database, this retrospective study compared all patients undergoing RYGB during the pre-ACA (2007-2009) and post-ACA (2018-2020) periods, including patient demographic factors, pre-existing conditions, and socioeconomic factors. RESULTS A total of 16,494 RYGB procedures were performed during the study period, of which 12,089 (73.3 %) were post-ACA. This was a 179.2 % increase in patients undergoing RYGB post-ACA; nearly triple that of the pre-ACA period. There was a significant decrease in uninsured patients (5.6 %-1.5 %, p < 0.01) an increase in Black patients (32.1 %-46.8 %, p < 0.01) and Medicaid beneficiaries (6.0 % pre-ACA to 17.8 % post-ACA, p < 0.01). There were significant reductions in adverse outcomes (long hospital stays, hemorrhage, GIT leaks, and mortality) across all insurance types (all p < 0.01). CONCLUSION The ACA increased access to RYGB procedures, especially in Black and Medicaid recipients in Maryland, enhancing healthcare across all insurance types.
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Affiliation(s)
- Oluwasegun A Akinyemi
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA.
| | - Terhas A Weldeslase
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Mojisola Fasokun
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA
| | - Yasmin Griffiths
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Tsion Andine
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Eunice Odusanya
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Mallory Williams
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Kakra Hughes
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Edward Cornwell
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
| | - Terrence Fullum
- Department of Surgery, Howard University College of Medicine, Washington, DC, USA
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Zhang X, Jaswal A, Quint J. Experience in Accessing Healthcare in Ethnic Minority Patients with Chronic Respiratory Diseases: A Qualitative Meta-Synthesis. Healthcare (Basel) 2023; 11:3170. [PMID: 38132060 PMCID: PMC10743025 DOI: 10.3390/healthcare11243170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Access to healthcare is part of every individual's human rights; however, many studies have illustrated that ethnic minority patients seem to be confronted with barriers when using healthcare services. Understanding how healthcare utilities are accessed from the perspective of patients and why healthcare disparities occur with patients from a minority background has the potential to improve health equality and care quality. This qualitative systematic review aims to gain insights into the experiences of people with chronic respiratory diseases (CRDs) from a minority background and explore factors contributing to their experiences in accessing healthcare to inform related health policy makers and healthcare providers. METHODS This systematic review complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, where the Joanna Briggs Institute meta-aggregative instrument facilitated the qualitative synthesis. The study protocol was registered with PROSPERO (CRD42022346055). PubMed, Scopus, Web of Science, and CINAHL were the databases explored. RESULTS From the papers selected, 47 findings were derived from 10 included studies, and four synthesised findings were generated: (1) the relationship between patients and healthcare professionals affects the usage of healthcare services; (2) patients' perceptions and cultural beliefs affect their compliance with disease management; (3) personal behaviours affect the usage of healthcare services; and (4) health resource inequalities have an impact on accessing healthcare services. CONCLUSIONS This systematic review demonstrates that ethnic minorities with CRDs face inequalities when engaging in healthcare. The relationship between patients and clinicians impacting the use of healthcare is the most pivotal discovery, where not speaking the same language and being of a different race alongside the accompanying criticism and faith in facilities are key contributors to this effect. In addition, the thinking patterns of these marginalised groups may reflect their cultural upbringing and diminish their engagement with therapies. This paper has uncovered ways to attenuate inequalities amongst ethnic minorities in engaging with healthcare providers and provides insight into building effective equity-promoting interventions in healthcare systems. To overcome these disparities, coaching doctors to communicate better with minority cohorts could help such patients to be more comfortable in connecting with medical facilities.
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Affiliation(s)
| | | | - Jennifer Quint
- School of Public Health, Imperial College London, London W12 0BZ, UK; (X.Z.); (A.J.)
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Gordon AJ, Dastagirzada Y, Schlacter J, Mehta S, Agrawal N, Golfinos JG, Lebowitz R, Pacione D, Lieberman S. Health Care Disparities in Transsphenoidal Surgery for Pituitary Tumors: An Experience from Neighboring Urban Public and Private Hospitals. J Neurol Surg B Skull Base 2023; 84:560-566. [PMID: 37854536 PMCID: PMC10581820 DOI: 10.1055/s-0042-1757613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/29/2022] [Indexed: 10/17/2022] Open
Abstract
Objectives Few studies have assessed the role of socioeconomic health care disparities in skull base pathologies. We compared the clinical history and outcomes of pituitary tumors at private and public hospitals to delineate whether health care disparities exist in pituitary tumor surgery. Methods We reviewed the records of patients who underwent transsphenoidal pituitary tumor resection at NYU Langone Health and Bellevue Hospital. Seventy-two consecutive patients were identified from each hospital. The primary outcome was time-to-surgery from initial recommendation. Secondary outcomes included postoperative diabetes insipidus, cerebrospinal fluid (CSF) leak, and gross total resection. Results Of 144 patients, 23 (32%) public hospital patients and 24 (33%) private hospital patients had functional adenomas ( p = 0.29). Mean ages for public and private hospital patients were 46.5 and 51.1 years, respectively ( p = 0.06). Private hospital patients more often identified as white ( p < 0.001), spoke English ( p < 0.001), and had private insurance ( p < 0.001). The average time-to-surgery for public and private hospital patients were 46.2 and 34.8 days, respectively ( p = 0.39). No statistically significant differences were found in symptom duration, tumor size, reoperation, CSF leak, or postoperative length of stay; however, public hospital patients more frequently required emergency surgery ( p = 0.03), developed transient diabetes insipidus ( p = 0.02), and underwent subtotal resection ( p = 0.04). Conclusion Significant socioeconomic differences exist among patients undergoing pituitary surgery at our institution's hospitals. Public hospital patients more often required emergency surgery, developed diabetes insipidus, and underwent subtotal tumor resection. Identifying these differences is an imperative initial step in improving the care of our patients.
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Affiliation(s)
- Alex J. Gordon
- NYU Grossman School of Medicine, NYU Langone Health, New York, New York, United States
| | - Yosef Dastagirzada
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - Jamie Schlacter
- NYU Grossman School of Medicine, NYU Langone Health, New York, New York, United States
| | - Sonal Mehta
- Division of Endocrinology, Department of Medicine, NYU Langone Health, New York, New York, United States
| | - Nidhi Agrawal
- Division of Endocrinology, Department of Medicine, NYU Langone Health, New York, New York, United States
| | - John G. Golfinos
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - Richard Lebowitz
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, United States
| | - Donato Pacione
- Department of Neurosurgery, NYU Langone Health, New York, New York, United States
| | - Seth Lieberman
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, United States
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Balas M, Jaja BNR, Harrington EM, Jack AS, Hofereiter J, Malhotra AK, Jaffe RH, He Y, Byrne JP, Wilson JR, Witiw CD. Earlier Tracheostomy Reduces Complications in Complete Cervical Spinal Cord Injury in Real-World Practice: Analysis of a Multicenter Cohort of 2001 Patients. Neurosurgery 2023; 93:1305-1312. [PMID: 37341486 DOI: 10.1227/neu.0000000000002575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/03/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES It is believed that early tracheostomy in patients with traumatic cervical spinal cord injury (SCI) may lessen the risk of developing complications and reduce the duration of mechanical ventilation and critical care stay. This study aims to assess whether early tracheostomy is beneficial in patients with traumatic cervical SCI. METHODS We conducted a retrospective cohort study using data from the American College of Surgeons Trauma Quality Improvement Program database from 2010 to 2018. Adult patients with a diagnosis of acute complete (ASIA A) traumatic cervical SCI who underwent surgery and tracheostomy were included. Patients were stratified into those receiving early (at or before 7 days) and delayed tracheostomy. Propensity score matching was used to assess the association between delayed tracheostomy and the risk of in-hospital adverse events. Risk-adjusted variability in tracheostomy timing across trauma centers was investigated using mixed-effects regression. RESULTS The study included 2001 patients from 374 North American trauma centers. The median time to tracheostomy was 9.2 days (IQR: 6.1-13.1 days), with 654 patients (32.7%) undergoing early tracheostomy. After matching, the odds of a major complication were significantly lower for early tracheostomy patients (OR: .90; 95% CI: .88-.98). Patients were also significantly less likely to experience an immobility-related complication (OR: .90; 95% CI: .88-.98). Patients in the early group spent 8.2 fewer days in the critical care unit (95% CI: -10.2 to -6.61) and 6.7 fewer days ventilated (95% CI: -9.44 to -5.23). There was significant variability in tracheostomy timeliness between trauma centers with a median odds ratio of 12.2 (95% CI: 9.7-13.7), which was not explained by case-mix and hospital-level characteristics. CONCLUSION A 7-day threshold to implement tracheostomy seems to be associated with reduced in-hospital complications, time in the critical care unit, and time on mechanical ventilation.
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Affiliation(s)
- Michael Balas
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , Canada
| | - Blessing N R Jaja
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto , Ontario , Canada
| | - Erin M Harrington
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , Canada
| | - Andrew S Jack
- Division of Neurosurgery, University of Alberta, Edmonton , Alberta , Canada
| | - Johann Hofereiter
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , Canada
| | - Armaan K Malhotra
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , Canada
| | - Rachael H Jaffe
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto , Ontario , Canada
| | - Yingshi He
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , Canada
| | - James P Byrne
- Department of Surgery, Johns Hopkins Hospital, Baltimore , Maryland , USA
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto , Ontario , Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto , Ontario , Canada
| | - Christopher D Witiw
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto , Ontario , Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto , Ontario , Canada
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Noubani M, Sethi I, McCarthy E, Stanley SL, Zhang X, Yang J, Spaniolas K, Pryor AD. The impact of interval cholecystectomy timing after percutaneous transhepatic cholecystostomy on post-operative adverse outcomes. Surg Endosc 2023; 37:9132-9138. [PMID: 37814166 DOI: 10.1007/s00464-023-10451-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/06/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE This study aims to explore how timing of interval of cholecystectomy (IC) after percutaneous transhepatic cholecystostomy tube (PTC) placement impacts post-operative outcomes. METHODS A retrospective database analysis of New York State SPARCs database of IC between 2005 and 2015. The timing for IC ranged between > 1 week and < 2 years. Patients undergoing this procedure were further divided into quartiles using 4-time intervals; 1-5 weeks (Q1), 5-8 weeks (Q2), 8-12 weeks(Q3), and > 12 weeks(Q4). The study's primary outcome was hospital length of stay (LOS). Secondary outcomes included discharge status, 30-day readmission, 30-day ED visit, and 90-day reoperation, surgery type, complication, and bile duct injury. Multivariable regression models were used to compare patients across the four-time intervals after adjusting for confounding factors. RESULTS A total of 1038 patients with a history of PTC followed by IC between > 1 week and < 2 years were included in the final analysis. The median time to IC was 7.7 weeks. Q2 and Q3 both had a significantly higher median LOS of 3 days versus Q1 and Q4 at median of 5 days (p < 0.0001). Patients from racial and ethnic minorities (e.g., African Americans and Hispanics) were more likely to get their IC after 12 weeks (p < 0.05). Further, Black patients had a significantly higher median LOS than White, non-Hispanic patients (8 days vs 4 days, p < 0.0001) and were more likely to have open procedure. Multivariable regression analysis identified shorter LOS during Q2 (Ratio, 0.76, 95%, 0.67-0.87, p < 0.0001), and Q3 (Ratio 0.75, 95% CI, 065-0.86, p < 0.0001) compared to those who got their IC in Q4. Similar findings exist when comparing Q2 and Q3 to those receiving treatment during Q1. CONCLUSION A time interval of 5-12 weeks between PTC and IC was associated with a decreased LOS. This study also suggests the persistence of racial disparities among these patients.
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Affiliation(s)
- Mohammad Noubani
- Department of Surgery, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27517, USA.
| | - Ila Sethi
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | | | - Samuel L Stanley
- Department of Anesthesiology, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Xiaoyue Zhang
- Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA
| | | | - Aurora D Pryor
- Department of Surgery, Northwell Health System, Manhasset, NY, USA
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Kashner TM, Greenberg PB, Birnbaum AD, Byrne JM, Sanders KM, Wilson MA, Bowman MA. Patient Surgical Outcomes When Surgery Residents Are the Primary Surgeon by Intensity of Surgical Attending Supervision in Veterans Affairs Medical Centers. ANNALS OF SURGERY OPEN 2023; 4:e351. [PMID: 38144505 PMCID: PMC10735144 DOI: 10.1097/as9.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/25/2023] [Indexed: 12/26/2023] Open
Abstract
Objective Using health records from the Department of Veterans Affairs (VA), the largest healthcare training platform in the United States, we estimated independent associations between the intensity of attending supervision of surgical residents and 30-day postoperation patient outcomes. Background Academic leaders do not agree on the level of autonomy from supervision to grant surgery residents to best prepare them to enter independent practice without risking patient outcomes. Methods Secondary data came from a national, systematic 1:8 sample of n = 862,425 teaching encounters where residents were listed as primary surgeon at 122 VA medical centers from July 1, 2004, through September 30, 2019. Independent associations between whether attendings had scrubbed or not scrubbed on patient 30-day all-cause mortality, complications, and 30-day readmission were estimated using generalized linear-mixed models. Estimates were tested for any residual confounding biases, robustness to different regression models, stability over time, and validated using moderator and secondary factors analyses. Results After accounting for potential confounding factors, residents supervised by scrubbed attendings in 733,997 nonemergency surgery encounters had fewer deaths within 30 days of the operation by 14.2% [0.3%, 29.9%], fewer case complications by 7.9% [2.0%, 14.0%], and fewer readmissions by 17.5% [11.2%, 24.2%] than had attendings not scrubbed. Over the 15 study years, scrubbed surgery attendings may have averted an estimated 13,700 deaths, 43,600 cases with complications, and 73,800 readmissions. Conclusions VA policies on attending surgeon supervision have protected patient safety while allowing residents in selected teaching encounters to have limited autonomy from supervision.
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Affiliation(s)
- T. Michael Kashner
- From the Office of Academic Affiliations, Department of Veterans Affairs, Washington, DC
- Department of Medicine, Loma Linda University Medical School, Loma Linda, CA
| | - Paul B. Greenberg
- VA Providence Healthcare System, Providence, RI
- Department of Surgery (Ophthalmology), The Warren Alpert Medical School of Brown University, Providence, RI
| | - Andrea D. Birnbaum
- From the Office of Academic Affiliations, Department of Veterans Affairs, Washington, DC
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John M. Byrne
- From the Office of Academic Affiliations, Department of Veterans Affairs, Washington, DC
- Department of Medicine, Loma Linda University Medical School, Loma Linda, CA
| | - Karen M. Sanders
- From the Office of Academic Affiliations, Department of Veterans Affairs, Washington, DC
- Department of Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Mark A. Wilson
- Department of Veterans Affairs, National Director of Surgery, National Office of Surgery (11SURG), Washington, DC
| | - Marjorie A. Bowman
- From the Office of Academic Affiliations, Department of Veterans Affairs, Washington, DC
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH
- Chief Academic Affiliations Officer, Department of Veterans Affairs, Washington, DC
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de Jager E, Levine AA, Sidey-Gibbons CJ, Udyavar NR, Liu C, Lamaina M, Maggard Gibbons MA, Ko CY, Burstin HR, Haider AH, Hoyt DB, Schoenfeld AJ, Weissman JS, Britt LD. Development and Validation of a Novel Literature-Based Method to Identify Disparity-Sensitive Surgical Quality Metrics. J Am Coll Surg 2023; 237:856-861. [PMID: 37703495 DOI: 10.1097/xcs.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Disparity in surgical care impedes the delivery of uniformly high-quality care. Metrics that quantify disparity in care can help identify areas for needed intervention. A literature-based Disparity-Sensitive Score (DSS) system for surgical care was adapted by the Metrics for Equitable Access and Care in Surgery (MEASUR) group. The alignment between the MEASUR DSS and Delphi ratings of an expert advisory panel (EAP) regarding the disparity sensitivity of surgical quality metrics was assessed. STUDY DESIGN Using DSS criteria MEASUR co-investigators scored 534 surgical metrics which were subsequently rated by the EAP. All scores were converted to a 9-point scale. Agreement between the new measurement technique (ie DSS) and an established subjective technique (ie importance and validity ratings) were assessed using the Bland-Altman method, adjusting for the linear relationship between the paired difference and the paired average. The limit of agreement (LOA) was set at 1.96 SD (95%). RESULTS The percentage of DSS scores inside the LOA was 96.8% (LOA, 0.02 points) for the importance rating and 94.6% (LOA, 1.5 points) for the validity rating. In comparison, 94.4% of the 2 subjective EAP ratings were inside the LOA (0.7 points). CONCLUSIONS Applying the MEASUR DSS criteria using available literature allowed for identification of disparity-sensitive surgical metrics. The results suggest that this literature-based method of selecting quality metrics may be comparable to more complex consensus-based Delphi methods. In fields with robust literature, literature-based composite scores may be used to select quality metrics rather than assembling consensus panels.
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Affiliation(s)
- Elzerie de Jager
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Adele A Levine
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Chris J Sidey-Gibbons
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - N Rhea Udyavar
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Charles Liu
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Margherita Lamaina
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Melinda A Maggard Gibbons
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Clifford Y Ko
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Helen R Burstin
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Adil H Haider
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - David B Hoyt
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Andrew J Schoenfeld
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - Joel S Weissman
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
| | - L D Britt
- From the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, MA (de Jager, Levine, Udyavar, Haider, Schoenfeld, Weissman)
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