title: Racial and ethnic disparities in the incidence and mortality from septic shock and respiratory failure among elective neurosurgery patients.
abstract: OBJECTIVE
  Septic shock (SS) and respiratory failure (RF) are serious complications after neurosurgical procedures. Research is limited in studying racial/ethnic disparities in incidence and mortality of SS and RF. The study aimed to determine the racial variation in incidence and mortality from SS and RF among elective neurosurgical patients in California.
  
  
  METHODS
  Data were analyzed from 206 902 admissions of elective neurosurgical patients in California from 2001 to 2009. Variables included race/ethnicity, age, gender, insurance, procedure site, and co-morbidities. We used descriptive, bivariate, and multivariate statistics in SAS v9·3.
  
  
  RESULTS
  Septic shock incidence was 0·30/1000/year and case fatality (CF) was 47·7%. Respiratory failure incidence was 4·7/1000/year and CF was 26·2%. Blacks had higher SS and RF (0·6 and 7·9%, respectively) compared to Whites (0·2 and 4·3%, respectively) (Chi-square, P < 0·01). In the adjusted logistic regression model, Blacks had higher odds of SS (Adjusted Odds Ratio [AOR]  =  1·56, 95% CI  =  1·16-2·10) and RF (AOR  =  1·22, 95% CI  =  1·11-1·33) relative to Whites. Although, Blacks had higher mortality from SS (58·9%) and RF (30·1%) compared to Whites (45·2 and 26·4%, respectively; P < 0·05), the AORs were not statistically significant (P > 0·05).
  
  
  CONCLUSIONS
  Blacks had a higher incidence of SS and RF. A higher percentage of black patients died from SS-related mortality, followed by Hispanics, than other groups. The attenuation of differences after statistical adjustment suggests the excess mortality may be due to age, site of the procedures, and having neoplastic disease. Our findings support the need for prospective studies to assess specific pre-operative interventions driven by age and co-morbidities that might reduce the risk of complications after neurosurgical procedures.
authors.forename: Alexander O
authors.initials: AO
authors.lastname: Firempong
authors.forename: Magda A
authors.initials: MA
authors.lastname: Shaheen
authors.forename: Deyu
authors.initials: D
authors.lastname: Pan
authors.forename: Doniel
authors.initials: D
authors.lastname: Drazin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002140:California; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D016017:Odds Ratio; D012131:Respiratory Insufficiency / Q000208:ethnology* / Q000401:mortality*; D012772:Shock, Septic / Q000208:ethnology* / Q000401:mortality*; D055815:Young Adult
keywords: Elective neurosurgical procedures,; Incidence and mortality,; Racial/ethnic disparities; Respiratory failure,; Septic shock,