Hispanic ethnicity and complication profile following laparoscopic and open cholecystectomy

Racial Disparities in General Surgery Outcomes

INTRODUCTION

While disparities in Black and Hispanic and Latino patients undergoing general surgeries are well described, most analyses leave out Asian, American Indian or Alaskan Native (AIAN), and native Hawaiian or Pacific Islander patients. This study identified general surgery outcomes for each racial group in the National Surgical Quality Improvement Program.

METHODS

National Surgical Quality Improvement Program was queried to identify all procedures conducted by a general surgeon from 2017 to 2020 (n = 2,664,197). Multivariable regression models were used to investigate the impact of race and ethnicity on 30-day mortality, readmission, reoperation, major and minor medical complications, and non-home discharge destinations. Adjusted odds ratios (AOR) and 95% confidence intervals were calculated.

RESULTS

Compared to non-Hispanic White patients, Black patients had higher odds of readmission and reoperation, and Hispanic and Latino patients had higher odds of major and minor complications. AIAN patients had higher odds of mortality (AOR: 1.003 (1.002-1.005), P < 0.001), major complication (AOR: 1.013 (1.006-1.020), P < 0.001), reoperation (AOR: 1.009, (1.005-1.013), P < 0.001), and non-home discharge destination (AOR: 1.006 (1.001-1.012), P = 0.025), while native Hawaiian or Pacific Islander patients had lower odds of readmission (AOR: 0.991 (0.983-0.999), P = 0.035) and non-home discharge destination (AOR: 0.983 (0.975-0.990), P < 0.001) compared to non-Hispanic White patients. Asian patients had lower odds of each adverse outcome.

CONCLUSIONS

Black, Hispanic and Latino, and AIAN patients are at higher odds for poor postoperative results than non-Hispanic White patients. AIANs had some of the highest odds of mortality, major complications, reoperation, and non-home discharge. Social health determinants and policy adjustments must be targeted to ensure optimal operative results for all patients.

Inaccurate Ethnicity and Race Classification of Hispanics Following Trauma Admission

BACKGROUND

Race and ethnicity are associated with disparate trauma outcomes. This study seeks to characterize accuracy of trauma registry classification of patient race and ethnicity and to identify factors associated with misclassification.

METHODS

A prospective observational study of patients admitted to an urban Level 1 trauma center was conducted over a 6-mo period. Race and ethnicity data recorded in the trauma registry were compared to patients' self-identifying data obtained through in-person interviews. Logistic regression determined rates of discordant race and ethnicity between trauma registry and patient self-identification processes, and identified factors independently associated with misclassification.

RESULTS

A total of 444 patients were recruited. 98 (22%) self-identified as Hispanic/Latino. 45 patients self-identifying as Hispanic (45.9%) had inaccurately recorded ethnicity in the trauma registry. There was an increased odds of ethnicity misclassification in younger patients (OR 0.97, P < 0.01) and Spanish-only speakers (OR 11.80, P < 0.001). A decreased odds was found in males (OR 0.43, P < 0.05). No factors increased odds of racial misclassification, while dual English/Spanish speakers (OR 0.05, P < 0.01) wereas found to have decreased odds. Neither ethnicity nor race misclassification was associated with clinical variables. New racial self-identification was observed with 75% of patients who self-identified ethnically as Hispanic also self-identifying racially as Hispanic.

CONCLUSIONS

Hispanic trauma patients have racial and ethnic misclassifications regardless of clinical status. Racial and ethnic identification is not sufficiently captured by current standardized questionnaires. Accuracy of hospital level racial data is important for local and national policies to address trauma disparities.

Cholecystectomy-Associated Complications in Kidney Transplant Recipients Compared With the General Population

Cholelithiasis is one of the most prevalent diseases in the general population. Among kidney transplant (KT) recipients, atypical clinical presentation may delay the diagnosis and proper treatment. This single-center retrospective cohort study compared cholelithiasis clinical presentation and cholecystectomy-associated complications in 230 KT recipients and in 172 members of the general population. KT recipients had a higher proportion of men, comorbidities, biliary pancreatitis, choledocholithiasis, and acute cholecystitis clinical presentations than the general population. KT recipients presented higher American Society of Anesthesiologists scores and higher rates of emergency surgeries (15.7% vs 9.9%, P = .091), conversion (5.7% vs 1.2%, P = .019), drainage (7.8% vs 2.3%, P = .016), postoperative complications (10% vs 4.7%, P = .047), and longer hospital length of stay (1 vs 1 days, interquartile range, 2 vs 0 days; P < .001). There were 5 deaths, all of which occurred in KT recipients. History of diabetes mellitus, renal function, and surgical conversion were independent risk factors associated with postoperative complications. Male sex and level of renal function were independent risk factors associated with postoperative acute cholecystitis. KT was an independent risk factor associated with postoperative choledocholithiasis (adjusted odds ratio, 5.89; 95% confidence interval, 3.03-15.66) and pancreatitis (adjusted odds ratio, 6.89; 95% confidence interval, 2.99-11.61). In conclusion, KT recipients with cholelithiasis have an increased risk for clinical and surgical complications compared with the general population.