title: Racial variation in the use of life-sustaining treatments among patients who die after major elective surgery.
abstract: BACKGROUND
  Although various studies have documented increased life-sustaining treatments among racial minorities in medical patients, whether similar disparities exist in surgical patients is unknown.
  
  
  METHODS
  A retrospective cohort study using the Nationwide Inpatient Sample (2006 to 2011) examining patients older than 39 years who died after elective colectomy was performed. Primary predictor variable was race, and main outcome was the use of life-sustaining treatment.
  
  
  RESULTS
  In univariate analysis, significant differences existed in use of cardiopulmonary resuscitation (CPR; black, 35.9%; Hispanic, 29.0%; other, 24.5%; white, 11.7%; P = .002) and reintubation (Hispanic, 75.0%; other, 69.0%; black, 52.3%; white, 45.2%; P = .01). In multivariate analysis, black (odds ratio [OR], 3.67; P = .01) and Hispanic (OR, 4.21; P = .03) patients were more likely to have undergone CPR, and Hispanic patients (OR, 4.24; P = .01) were more likely to have been reintubated (reference: white).
  
  
  CONCLUSIONS
  Blacks and Hispanics had increased odds of experiencing CPR, and Hispanics were more likely to have been reintubated before death after a major elective operation. These variations may imply worse quality of death and increased associated costs.
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Roland A
authors.initials: RA
authors.lastname: Hernandez
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Nathanael D
authors.initials: ND
authors.lastname: Hevelone
authors.affiliation: Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA; Disparities Solutions Center, Massachusetts General Hospital, Boston, MA, USA; Department of General Medicine, Massachusetts General Hospital and Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Lenny
authors.initials: L
authors.lastname: Lopez
authors.affiliation: Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Samuel R G
authors.initials: SR
authors.lastname: Finlayson
authors.affiliation: Division of Pain and Palliative Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Eva
authors.initials: E
authors.lastname: Chittenden
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA. Electronic address: zcooper@partners.org.
authors.forename: Zara
authors.initials: Z
authors.lastname: Cooper
mesh_terms: D001741:Black or African American; D000368:Aged; D015331:Cohort Studies; D003082:Colectomy / Q000401:mortality*; D017558:Elective Surgical Procedures / Q000401:mortality*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008020:Life Support Care / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D044465:White People
keywords: End-of-life care; Life-sustaining treatment; Quality of death; Racial disparities