title: Understanding Racial and Ethnic Disparities in Postsurgical Complications Occurring in U.S. Hospitals.
abstract: To examine the role of patient, hospital, and community characteristics on racial and ethnic disparities in in-hospital postsurgical complications.
  
  
  
  Healthcare Cost and Utilization Project, 2011 State Inpatient Databases; American Hospital Association Annual Survey of Hospitals; Area Health Resources Files; Centers for Medicare & Medicaid Services Hospital Compare database.
  
  
  
  Nonlinear hierarchical modeling was conducted to examine the odds of patients experiencing any in-hospital postsurgical complication, as defined by Agency for Healthcare Research and Quality Patient Safety Indicators.
  
  
  
  A total of 5,474,067 inpatient surgical discharges were assessed using multivariable logistic regression. Clinical risk, payer coverage, and community-level characteristics (especially income) completely attenuated the effect of race on the odds of postsurgical complications. Patients without private insurance were 30 to 50 percent more likely to have a complication; patients from low-income communities were nearly 12 percent more likely to experience a complication. Private, not-for-profit hospitals in small metropolitan or micropolitan areas and higher nurse-to-patient ratios led to fewer postsurgical complications.
  
  
  
  Race does not appear to be an important determinant of in-hospital postsurgical complications, but insurance and community characteristics have an effect. A population-based approach that includes improving the socioeconomic context may help reduce disparities in these outcomes.
authors.affiliation: Maternal and Child Health Research, Truven Health Analytics, Inc., 4819 Emperor Boulevard, Suite 125, Durham, NC 27703.
authors.forename: Whitney P
authors.initials: WP
authors.lastname: Witt
authors.affiliation: Federal Government, Truven Health Analytics, Inc., Bethesda, MD.
authors.forename: Rosanna M
authors.initials: RM
authors.lastname: Coffey
authors.affiliation: Life Sciences, Truven Health Analytics, Inc., Austin, TX.
authors.forename: Lorena
authors.initials: L
authors.lastname: Lopez-Gonzalez
authors.affiliation: ML Barrett INC, San Diego, CA.
authors.forename: Marguerite L
authors.initials: ML
authors.lastname: Barrett
authors.affiliation: Federal Government, Truven Health Analytics, Inc., Bethesda, MD.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Moore
authors.affiliation: Center for Organization and Delivery Studies, Agency for Healthcare Research and Quality, Rockville, MD.
authors.forename: Roxanne M
authors.initials: RM
authors.lastname: Andrews
authors.affiliation: Department of Health and Human Services, Agency for Healthcare Research and Quality, Rockville, MD.
authors.forename: Raynard E
authors.initials: RE
authors.lastname: Washington
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D011183:Postoperative Complications / Q000453:epidemiology* / Q000208:ethnology; D011203:Poverty / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
keywords: Postsurgical complications; community socioeconomic status; health disparities; health insurance; racial/ethnic differences in health care; surgery