title: Race-based differences in length of stay among patients undergoing pancreatoduodenectomy.
abstract: BACKGROUND
  Race-based disparities in operative morbidity and mortality have been demonstrated for various procedures, including pancreatoduodenectomy (PD). Race-based differences in hospital length-of-stay (LOS), especially related to provider volume at the surgeon and hospital level, remain poorly defined.
  
  
  METHODS
  Using the 2003-2009 Nationwide Inpatient Sample, we determined year-specific PD volumes for surgeons and hospitals and grouped them into terciles. Patient race (white, black, or Hispanic), age, sex, and comorbidities were examined. Median length of stay was calculated, and multivariable logistic regression was used to examine factors associated with increased LOS.
  
  
  RESULTS
  Among 4,319 eligible individuals, 3,502 (81.1%) were white, 423 (9.8%) were black, and 394 (9.1%) were Hispanic. Overall median LOS was 12 days (range, 0-234). Median annual surgeon volume was 8 (interquartile range [IQR], 2-19; range, 1-54). Annual hospital volume ranged from 1 to 129 (median, 19; IQR, 7-55). White patients were more likely to have been treated at medium- to high-volume hospitals (odds ratio [OR] 1.53, P < .001) and by medium- to high-volume surgeons (OR 1.62, P < .001) than black or Hispanic patients. After PD, white, black, and Hispanic patients demonstrated similar in-hospital mortality (5.1%, 5.7% and 7.2% respectively P = .250). After adjustment, black (OR 1.36, P = .010) and Hispanic (OR 1.68, P < .001) patients were more likely to have a greater LOS after PD.
  
  
  CONCLUSIONS
  Black and Hispanic PD patients were less likely than white patients to be treated at higher-volume hospitals and by higher-volume surgeons. Proportional mortality and LOS after PD were greater among black and Hispanic patients.
authors: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
authors: Eric B
authors: EB
authors: Schneider
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Keri L
authors: KL
authors: Calkins
authors: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
authors: Matthew J
authors: MJ
authors: Weiss
authors: Department of Radiation Oncology, Johns Hopkins School of Medicine, Baltimore, MD.
authors: Joseph M
authors: JM
authors: Herman
authors: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
authors: Christopher L
authors: CL
authors: Wolfgang
authors: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
authors: Martin A
authors: MA
authors: Makary
authors: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
authors: Nita
authors: N
authors: Ahuja
authors: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
authors: Adil H
authors: AH
authors: Haider
authors: Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD. Electronic address: tpawlik1@jhmi.edu.
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D001741:Black or African American; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D013502:General Surgery; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology; D044469:Racial Groups; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D044465:White People