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Identifying Population-Level and Within-Hospital Disparities in Surgical Care.

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Area of Science:

  • Health Services Research
  • Surgical Quality Improvement
  • Health Equity

Background:

  • Lack of consensus on equity measurement hinders addressing disparities in surgical care.
  • Hospital and system-level quality assessment programs may not adequately incorporate equity.
  • This study addresses the need to identify population-level and within-hospital differences in surgical care quality.

Purpose of the Study:

  • To identify population-level disparities in surgical care quality.
  • To identify within-hospital disparities in surgical care quality.
  • To analyze disparities by Area Deprivation Index (ADI), race, and ethnicity.

Main Methods:

  • Analysis of 657 hospitals and over 4 million patients from the National Surgical Quality Improvement Program (NSQIP) database (2014-2018).
  • Utilized multilevel random slope, random intercept modeling to assess population-level and in-hospital disparities.
  • Examined 5 quality measures: mortality, readmission, surgical site infection, colectomy mortality, and spine surgery complications.

Main Results:

  • Population-level disparities were found across all measures by ADI, and for Black race in 2 measures (readmissions, spine surgery complications).
  • No population-level disparities were detected for Hispanic ethnicity.
  • After risk adjustment, less than 1.1% of hospitals showed significant within-hospital disparities by ADI, race, or ethnicity.

Conclusions:

  • Significant in-hospital disparities in surgical care were rare after risk adjustment.
  • Disparities were more frequently identified by ADI compared to race and ethnicity.
  • Potential reasons for limited detected in-hospital disparities include postoperative metrics, sample size, and risk adjustment methods; further research on access and segregation is warranted.