African Americans and Short-Term Outcomes after Surgery for Crohn's Disease: An ACS-NSQIP Analysis.
BACKGROUND
Previous reports on racial disparities in the treatment of Crohn's disease [CD] in African American [AA] patients have shown differences in both medical and surgical treatments in this population. No study thus far has examined the effect of AA race on outcomes after surgery for CD.


METHODS
Utilizing the National Surgical Quality Improvement Program [NSQIP] Participant User File [PUF] for the years 2005-2013, we examined the effect of AA race on postoperative complications in patients with CD undergoing intestinal surgery.


RESULTS
AA patients had a significantly higher rate of complications overall compared to non-AA patients [23.5% vs 18.9%, p = 0.002]. Postoperative sepsis [10.9% vs 6.6%, p < 0.001] and surgical site infection [17.6% vs 14.8%, p = 0.037] were most significant. After adjustment for age, sex, preoperative disease severity and lifestyle factors [smoking], race remained a statistically significant factor in postoperative complication rate. Only after additional adjustment was made for comorbidities and American Society of Anesthesiologists class did race lose significance within our model.


CONCLUSIONS
African Americans experience a greater amount of postoperative complications following surgery for Crohn's disease. Preoperative disease management, addressing smoking status and control of comorbid disease are important factors in addressing the racial disparities in the surgical treatment of Crohn's disease.
Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.|Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA.
Elliot G
EG
Arsoniadis
Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
Yen-Yi
YY
Ho
Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA.|Division of Colon & Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Genevieve B
GB
Melton
Division of Colon & Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Robert D
RD
Madoff
Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
Chap
C
Le
Division of Colon & Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Mary R
MR
Kwaan
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D003424:Crohn Disease / Q000208:ethnology / Q000601:surgery*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000208:ethnology* / Q000209:etiology; D018805:Sepsis / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology; D016896:Treatment Outcome
African Americans; Crohn’s disease; National Surgical Quality Improvement Program; healthcare disparities; minority health
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