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Development and Assessment of a Systematic Approach for Detecting Disparities in Surgical Access.

Jan H Wong¹, William D Irish^2,3, Eric J DeMaria⁴

¹Division of Surgical Oncology, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina.

|December 16, 2020

Summary

This study developed a method to identify surgical access disparities, finding lower-ranked counties had significantly less access to general surgery and emergent procedures compared to higher-ranked counties.

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Area of Science:

Health Services Research
Surgical Outcomes
Health Equity

Background:

Optimal surgical access is crucial for quality healthcare, yet methods to identify disparities are lacking.
Understanding surgical access disparities is key to addressing inequities in care delivery.

Purpose of the Study:

To develop and apply a systematic approach for detecting disparities in surgical access.
To quantify surgical access disparities between counties with differing health outcome rankings.

Main Methods:

A cross-sectional study utilized 2016 Health Cost and Utilization Project State Inpatient Database data from North Carolina.
The proportional surgical ratio (PSR) was calculated by comparing observed surgical rates in lower-ranked counties (LRCs) to expected rates based on higher-ranked counties (HRCs).
Included were adult inpatient general surgery procedures and emergency cholecystectomies, herniorrhaphies, and bariatric surgeries.

Main Results:

The proportional surgical ratio (PSR) for general surgery in LRCs was 1.40, indicating reduced access compared to HRCs.
Emergent cholecystectomy (PSR=2.26) and herniorrhaphy (PSR=1.83) access was also significantly lower in LRCs.
LRCs had higher obesity rates (36.6% vs 25.4%) but lower bariatric surgery rates (PSR=0.60) compared to HRCs.

Conclusions:

The proportional surgical ratio (PSR) provides a systematic method to define and measure surgical access disparities.
Findings highlight significant disparities in surgical access, particularly for emergent procedures, impacting vulnerable populations.
This approach can guide interventions aimed at mitigating surgical access inequities.