Disparities in surgical outcomes in Medicare Advantage vs traditional Medicare

To evaluate differences in disparities in surgical outcomes between beneficiaries enrolled in Medicare Advantage (MA) vs traditional Medicare (TM).

We conducted a retrospective cross-sectional study of Medicare beneficiaries 65 years and older undergoing common abdominal operations (appendectomy, cholecystectomy, colectomy, hernia repair) between 2016 and 2020. The primary exposures were enrollment in MA and race/ethnicity.

We performed propensity score-weighted difference-in-disparities analyses comparing Black-White and Hispanic-White disparities in MA vs TM for in-hospital mortality and 30-day mortality, complications, serious complications, and readmissions.

Overall, 1,603,887 Medicare beneficiaries were included in the study, of whom 35% were enrolled in MA. Enrollment in MA was associated with no differences in Black-White disparities in postoperative mortality or complications. Hispanic-White disparities in 30-day mortality were 0.83 percentage points smaller (95% CI, -1.41 to -0.25; P = .01) and in postoperative complications were 1.24 percentage points smaller (95% CI, -2.16 to -0.32; P = .01) for MA beneficiaries compared with TM beneficiaries. There were no differences in disparities between MA and TM for readmissions.

MA was associated with no differences in Black-White disparities, smaller Hispanic-White disparities in postoperative mortality and complications, and no differences in readmissions. These findings may reflect potential features of MA that narrow gaps in surgical disparities but not uniformly. Future work should examine mechanisms that could impact perioperative outcomes for racial/ethnic minorities, including referral networks, care management, or cost sharing.