Disparate use of minimally invasive surgery in benign surgical conditions.
BACKGROUND
Disparities in outcome across race and ethnicity have been consistently described for medical and surgical care. Given that surgery is a rapidly evolving field, we hypothesized that racial disparities exist in access to minimally invasive surgery (MIS), which importantly influences outcome.


METHODS
Cohort analysis of all patients who underwent appendectomy, gastric fundoplication, and gastric bypass in the Nationwide Inpatient Sample, a 20% stratified random sample of US hospital discharge abstracts. To determine the effect of race on the use of MIS techniques and morbidity and mortality, we controlled for patient characteristics, comorbidity, and hospital characteristics including surgical volume and MIS conversion to open surgery.


RESULTS
Blacks were consistently less likely to be treated with MIS despite adjustment for socioeconomic status, comorbidity, and treatment setting. In addition, in-hospital mortality and complications such as pneumonia, heart disease, infections, and surgical misadventures were higher in black than white patients. These outcomes differences remained despite adjustment for hospital volume, the use of MIS, and MIS conversion to open surgery.


CONCLUSIONS
We demonstrate evidence of racial disparities in the use of MIS for benign surgical conditions and worse outcomes for patients of black race. Although, the racial differences in outcome were attenuated with adjustment for MIS, further studies are needed to help resolve remaining differences in outcomes across race.
Ricciardi
Rocco
R
Department of Colon and Rectal Surgery, Lahey Clinic, Tufts University, 41 Mall Road, Burlington, MA 01805, USA. rocco.ricciardi@lahey.org
Selker
Harry P
HP
Baxter
Nancy N
NN
Marcello
Peter W
PW
Roberts
Patricia L
PL
Virnig
Beth A
BA
D001741:Black or African American / Q000706:statistics & numerical data; D001062:Appendectomy / Q000379:methods / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D018662:Fundoplication / Q000379:methods / Q000706:statistics & numerical data*; D015390:Gastric Bypass / Q000379:methods / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000706:statistics & numerical data; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D044469:Racial Groups / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States