Racial disparity in surgical mortality after major hepatectomy.
BACKGROUND
The relationship between surgical mortality and race has not been studied for major hepatectomy. We sought to quantify and explore the nature of racial disparities in surgical mortality after major hepatectomy in a nationally representative cohort of patients.


METHODS
We conducted a retrospective cohort study using data from the Nationwide Inpatient Sample (1998 to 2005). Adult patients undergoing major hepatectomy within 1 day of nontrauma admission were included. Logistic regression models were used to assess the variation of in-hospital mortality by race after adjustment for other risk factors.


RESULTS
The study cohort consisted of 3,552 observations representing 17,794 patients undergoing major hepatectomy. Unadjusted analyses revealed that African-American patients had a two-fold increased odds of surgical mortality (odds ratio 2.22, 95% CI 1.38 to 3.57) relative to Caucasians. Even after adjustment for other risk factors, African Americans had a two-fold increased odds of surgical mortality (odds ratio 2.15, 95% CI 1.28 to 3.61) relative to Caucasians. Stratified analyses restricting the cohort to patients without comorbidities, those with neoplasms, those with private insurance, or those treated at high-volume hospitals all demonstrated racial disparities in surgical mortality.


CONCLUSIONS
In-hospital mortality after major hepatectomy varies substantially by race. After adjustment for potential confounders, African-American patients have two-fold higher population-level odds of surgical mortality than Caucasian patients do. Our analyses suggest that clinical factors, insurance status, and hospital factors do not account for these differences. Additional studies to clarify the nature of this disparity and identify targets for intervention are warranted.
Nathan
Hari
H
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Frederick
Wayne
W
Choti
Michael A
MA
Schulick
Richard D
RD
Pawlik
Timothy M
TM
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001650:Bile Duct Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000601:surgery; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006498:Hepatectomy / Q000401:mortality*; D006525:Hepatitis, Viral, Human / Q000208:ethnology* / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000208:ethnology* / Q000401:mortality / Q000601:surgery; D008113:Liver Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D014481:United States; D044465:White People / Q000706:statistics & numerical data*