TRENDS IN RACIAL DISPARITIES IN SURGICAL CARE FOR IBD PATIENTS
Kenneth D. Allen*2, Mahmoud Abdel-Rasoul2, Anita Afzali1, Syed Husain2
1University of Cincinnati Health, Cincinnati, OH; 2The Ohio State University Wexner Medical Center, Columbus, OH
Introduction
Recently, the use of minimally invasive surgery has been identified as a surrogate for quality of surgical care, while rates of emergent surgery are a surrogate for access to care. It has been demonstrated that health care outcomes may be more dependent on socioeconomic status and access to care than biologic factors. While significant advancements have been made in the management of patients with inflammatory bowel disease (IBD), it seems that the presence of disparate outcomes between black and white patients has not changed. We utilized the American College of Surgeons National Surgery Quality Improvement Program (NSQIP) database to evaluate trends in the rates of emergent operations, use of laparoscopic surgery and surgical outcomes comparing black and white patients.
Materials and Methods
The NSQIP database from the year 2012 to 2020 was used to evaluate trends in emergency surgery, laparoscopy and outcomes in IBD patients undergoing colectomy. IBD patients were identified using ICD codes for Crohn's disease (ICD9: 555.x; ICD10 K50.x) and ulcerative colitis (ICD9: 556.x; ICD10 K51.x). The primary outcomes were rates of emergent and laparoscopic surgery over time. Secondary outcomes were length of stay and complication rates. Categorical variables were analyzed using Chi-square test, continuous variables using the Student's t-test or Wilcoxon rank sums test, and proportions of laparoscopic and emergent surgeries using logistic regression modeling.
Results
There were 18,979 patients with IBD with race of either white (17,220) or black (1759) in the study period. The utilization of laparoscopic surgery is increasing at a greater rate in white patients compared to black patients (Figure 1), while emergent surgeries are remaining similar (Figure 2). The rates of any complication (25.7% vs 21.1%, p <0.0001) and major complication (23.2% vs 17.9%, p <0.0001) were higher in black patients. In subgroup analysis of patients undergoing laparoscopic surgery, rates of any complication were similar (17.9% vs 15.7%, p = 0.07), while major complications were more frequent in black patients (16.1% vs 13.2%, p = 0.01). Median post-operative length of stay was higher in black patients (6 days vs 5, p <0.0001).
Conclusion
There was an overall increase in the rate of laparoscopic surgery between 2012 and 2020 in IBD patients undergoing colectomy, however this disproportionately represented white patients. Additionally, black patients experienced greater post operative length of stay and increased complications compared to white patients, a disparity which is attenuated in the laparoscopic surgery group. These results raise concerns that while access to care is improving based on the declining rate of emergent surgeries, quality of surgical care is not improving. Further research is required to explore the underlying factors contributing to this disparity.
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