title: Examining Causes of Racial Disparities in General Surgical Mortality: Hospital Quality Versus Patient Risk.
abstract: BACKGROUND
  Racial disparities in general surgical outcomes are known to exist but not well understood.
  
  
  OBJECTIVE
  To determine if black-white disparities in general surgery mortality for Medicare patients are attributable to poorer health status among blacks on admission or differences in the quality of care provided by the admitting hospitals.
  
  
  METHODS
  Matched cohort study using Tapered Multivariate Matching.
  
  
  METHODS
  All black elderly Medicare general surgical patients (N=18,861) and white-matched controls within the same 6 states or within the same 838 hospitals.
  
  
  METHODS
  Thirty-day mortality (primary); others include in-hospital mortality, failure-to-rescue, complications, length of stay, and readmissions.
  
  
  RESULTS
  Matching on age, sex, year, state, and the exact same procedure, blacks had higher 30-day mortality (4.0% vs. 3.5%, P<0.01), in-hospital mortality (3.9% vs. 2.9%, P<0.0001), in-hospital complications (64.3% vs. 56.8% P<0.0001), and failure-to-rescue rates (6.1% vs. 5.1%, P<0.001), longer length of stay (7.2 vs. 5.8 d, P<0.0001), and more 30-day readmissions (15.0% vs. 12.5%, P<0.0001). Adding preoperative risk factors to the above match, there was no significant difference in mortality or failure-to-rescue, and all other outcome differences were small. Blacks matched to whites in the same hospital displayed no significant differences in mortality, failure-to-rescue, or readmissions.
  
  
  CONCLUSIONS
  Black and white Medicare patients undergoing the same procedures with closely matched risk factors displayed similar mortality, suggesting that racial disparities in general surgical mortality are not because of differences in hospital quality. To reduce the observed disparities in surgical outcomes, the poorer health of blacks on presentation for surgery must be addressed.
authors.affiliation: *Center for Outcomes Research, The Children's Hospital of Philadelphia Departments of †Pediatrics ‡Anesthesiology and Critical Care, The Perelman School of Medicine §Department of Health Care Management, The Wharton School ∥The Leonard Davis Institute of Health Economics ¶Department of Statistics, The Wharton School #Department of Surgery, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA **Center for Health Disparities Solutions, The Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, MD.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Silber
authors.forename: Paul R
authors.initials: PR
authors.lastname: Rosenbaum
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
authors.forename: Darrell J
authors.initials: DJ
authors.lastname: Gaskin
authors.forename: Justin M
authors.initials: JM
authors.lastname: Ludwig
authors.forename: Richard N
authors.initials: RN
authors.lastname: Ross
authors.forename: Bijan A
authors.initials: BA
authors.lastname: Niknam
authors.forename: Alex
authors.initials: A
authors.lastname: Hill
authors.forename: Min
authors.initials: M
authors.lastname: Wang
authors.forename: Orit
authors.initials: O
authors.lastname: Even-Shoshan
authors.forename: Lee A
authors.initials: LA
authors.lastname: Fleisher
mesh_terms: D001741:Black or African American; D000368:Aged; D005260:Female; D013502:General Surgery / Q000592:standards*; D006302:Health Services Research; D006304:Health Status; D054625:Healthcare Disparities / Q000208:ethnology*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare; D010359:Patient Readmission / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D014481:United States; D044465:White People