title: Examination of Racial Disparities in the Receipt of Minimally Invasive Surgery Among a National Cohort of Adult Patients Undergoing Colorectal Surgery.
abstract: BACKGROUND
  Racial disparities in outcomes are well described among surgical patients.
  
  
  OBJECTIVE
  The purpose of this work was to identify any racial disparities in the receipt of a minimally invasive approach for colorectal surgery.
  
  
  METHODS
  Adults undergoing colorectal surgery were studied using the University HealthSystem Consortium. Univariate and multivariable analyses were used to identify predictors for the receipt of a minimally invasive approach.
  
  
  METHODS
  The study was conducted at academic hospitals and their affiliates.
  
  
  METHODS
  Adults ≥18 years of age who underwent surgery for colorectal cancer, diverticular disease, IBD, or benign colorectal tumor between 2008 and 2011 were included.
  
  
  METHODS
  The receipt of a minimally invasive surgical approach was the main measured outcome.
  
  
  RESULTS
  A total of 82,474 adult patients met the study inclusion criteria. Of these, 69,664 (84%) were white, 10,874 (13%) were black, and 1936 (2%) were Asian. Blacks were younger, with higher rates of public insurance and higher comorbidity burden and baseline severity of illness compared with white and Asian patients. Black patients were less likely (adjusted OR = 0.83 (95% CI, 0.79-0.87)) and Asian patients more likely (adjusted OR = 1.34 (95% CI, 1.21-1.49)) than whites to receive minimally invasive surgery. This association did not change with stratification by insurance type (public or private). Black patients had higher rates of intensive care unit admission and nonhome discharge, as well as an increased length of stay compared with white and Asian patients. No differences in complications, readmission, or mortality rates were observed with minimally invasive surgery, but black patients were more likely to be readmitted or to die with open surgery.
  
  
  CONCLUSIONS
  The study was limited by the retrospective nature of its data.
  
  
  CONCLUSIONS
  We identified racial differences in the receipt of a minimally invasive approach for colorectal surgery, regardless of insurance status, as well as improved outcomes for minority races who underwent a minimally invasive technique compared with open surgery. The improved outcomes associated with minimally invasive surgery should prompt efforts to increase rates of its use among black patients.
authors.affiliation: 1 Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts 2 Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts 3 Division of Colorectal Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts.
authors.forename: Rachelle N
authors.initials: RN
authors.lastname: Damle
authors.forename: Julie M
authors.initials: JM
authors.lastname: Flahive
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Davids
authors.forename: Justin A
authors.initials: JA
authors.lastname: Maykel
authors.forename: Paul R
authors.initials: PR
authors.lastname: Sturrock
authors.forename: Karim
authors.initials: K
authors.lastname: Alavi
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000706:statistics & numerical data; D003108:Colonic Diseases / Q000208:ethnology / Q000601:surgery; D003107:Colorectal Surgery / Q000379:methods / Q000706:statistics & numerical data; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement; D012002:Rectal Diseases / Q000208:ethnology / Q000601:surgery; D012189:Retrospective Studies; D014481:United States