title: The impact of race on outcomes following emergency surgery: an American College of Surgeons National Surgical Quality Improvement Program assessment.
abstract: BACKGROUND
  Despite significant evolutions in health care, outcome discrepancies exist among demographic cohorts. We sought to determine the impact of race on emergency surgery outcomes.
  
  
  METHODS
  This is a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database (2005 through 2009) for all patients aged ≥16 years undergoing emergency abdominal surgery. Primary outcomes included morbidity and mortality.
  
  
  RESULTS
  We identified 75,280 patients (mean age 48.2 ± 19.9 years, 51.7% female; 79% white, 9.9% black, 5.0% Hispanic, 3.7% Asian, 1.3% American Indian or Alaskan, .2% Pacific Islander). Annual rates of emergency operations ranged from 7.3% to 8.5% (P = .22). The overall complication (18.6%) and mortality rate (4.6%) was highest in the black population (24.3%, 5.3%) followed by whites (18.7%, 4.6%), with the lowest rate in Hispanic (11.7%, 1.8%) and Pacific Islander populations (10.2%, 1.8%; P < .001). Compared with whites, blacks had a 1.25-fold (1.17 to 1.34; P < .001) increased risk of complications, but similar mortality (P = .168). When combining minorities, overall complications were 1.059-fold (1.004 to 1.12; P = .034) higher, however, mortality was reduced 1.7-fold (1.07 to 1.34; P = .001).
  
  
  CONCLUSIONS
  Following emergency abdominal surgery, minority race is independently associated with increased complications and reduced mortality.
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Ft. Lewis, WA, USA.
authors.forename: Marlin Wayne
authors.initials: MW
authors.lastname: Causey
authors.forename: Derek
authors.initials: D
authors.lastname: McVay
authors.forename: Quinton
authors.initials: Q
authors.lastname: Hatch
authors.forename: Eric
authors.initials: E
authors.lastname: Johnson
authors.forename: Justin A
authors.initials: JA
authors.lastname: Maykel
authors.forename: Brad
authors.initials: B
authors.lastname: Champagne
authors.forename: Scott R
authors.initials: SR
authors.lastname: Steele
mesh_terms: D000328:Adult; D000368:Aged; D004638:Emergency Treatment / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D009017:Morbidity; D015999:Multivariate Analysis; D015397:Program Evaluation; D058996:Quality Improvement; D044469:Racial Groups; D012189:Retrospective Studies; D012955:Societies, Medical; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000592:standards*; D014481:United States
keywords: Emergency surgery; Ethnicity; Outcomes; Race