title: Racial disparities in operative procedure time: the influence of obesity.
abstract: BACKGROUND
  Using Pennsylvania Medicare claims from 1995 to 1996, the authors previously reported that anesthesia procedure length appears longer in blacks than whites. In a new study using a different and larger data set, the authors now examine whether body mass index (BMI), not available in Medicare claims, explains this difference. The authors also examine the relative contributions of surgical and anesthesia times.
  
  
  METHODS
  The Obesity and Surgical Outcomes Study of 47 hospitals throughout Illinois, New York, and Texas abstracted chart information including BMI on elder Medicare patients (779 blacks and 14,596 whites) undergoing hip and knee replacement and repair, colectomy, and thoracotomy between 2002 and 2006. The authors matched all black Medicare patients to comparable whites and compared procedure lengths.
  
  
  RESULTS
  Mean BMI in the black and white populations was 30.24 and 28.96 kg/m, respectively (P<0.0001). After matching on age, sex, procedure, comorbidities, hospital, and BMI, mean white BMI in the comparison group was 30.1 kg/m (P=0.94). The typical matched pair difference (black-white) in anesthesia (induction to recovery room) procedure time was 7.0 min (P=0.0019), of which 6 min reflected the surgical (cut-to-close) time difference (P=0.0032). Within matched pairs, where the difference in procedure times was greater than 30 min between patients, blacks more commonly had longer procedure times (Odds=1.39; P=0.0008).
  
  
  CONCLUSIONS
  Controlling for patient characteristics, BMI, and hospital, elder black Medicare patients experienced slightly but significantly longer procedure length than their closely matched white controls. Procedure length difference was almost completely due to surgery, not anesthesia.
authors.affiliation: Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. silberj@wharton.upenn.edu
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Silber
authors.forename: Paul R
authors.initials: PR
authors.lastname: Rosenbaum
authors.forename: Richard N
authors.initials: RN
authors.lastname: Ross
authors.forename: Orit
authors.initials: O
authors.lastname: Even-Shoshan
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
authors.forename: Mark D
authors.initials: MD
authors.lastname: Neuman
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Reinke
authors.forename: Justin M
authors.initials: JM
authors.lastname: Ludwig
authors.forename: Fabienne A
authors.initials: FA
authors.lastname: Kyle
authors.forename: Dale W
authors.initials: DW
authors.lastname: Bratzler
authors.forename: Lee A
authors.initials: LA
authors.lastname: Fleisher
mesh_terms: D000367:Age Factors; D000465:Algorithms; D000768:Anesthesia, General; D044383:Black People; D015992:Body Mass Index; D015897:Comorbidity; D005006:Ethnicity / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D038801:International Classification of Diseases; D006278:Medicare; D009765:Obesity / Q000150:complications* / Q000453:epidemiology*; D012307:Risk Factors; D012737:Sex Factors; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D044465:White People; D001741:Black or African American