Racial disparity in surgical complications in New York State
Kevin Fiscella1, Peter Franks, Sean Meldrum
1Department of Family Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA. Kevin_Fiscella@URMC.rochester.edu
Objective:
To examine the relationship between race and surgical complications.
Summary Background Data:
Blacks have been reported to experience higher rates of surgical complications than whites, but the reasons are not known.
Methods:
The effect of the black race on risk of any surgical complication (from the Agency for Healthcare Research and Quality's patient safety indicators) was examined using New York State (NYS) hospital discharge data from 1998 to 2000. Sequential, hierarchical analyses controlled for: 1) patient age and gender, 2) morbidity length of stay, 3) individual social factors, 4) hospital characteristics, and 5) ecologic factors (region of state, percent black and Medicaid annual discharges, and mean income of admitted patients).
Results:
Following adjustment for patient age and gender, blacks had 65% higher odds for a surgical complication. Further adjustment for comorbidity and length of stay (LOS) reduced the odds substantially to 1.18. Additional adjustment for American Hospital Association hospital characteristics essentially eliminated the risk. Final adjustment for hospital ecologic variables reduced the odds to 1.0.
Conclusions:
Higher rates of surgical complications among blacks than whites in NYS are primarily explained by differences in comorbidity LOS and the hospital where the surgery occurred.