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Examination of Racial Disparities in the Receipt of Minimally Invasive Surgery Among a National Cohort of Adult Patients Undergoing Colorectal Surgery

Damle, Rachelle N. M.D., M.S.; Flahive, Julie M. M.S.; Davids, Jennifer S. M.D.; Maykel, Justin A. M.D.; Sturrock, Paul R. M.D.; Alavi, Karim M.D., M.P.H.

doi: 10.1097/DCR.0000000000000692
Original Contributions: Socioeconomic Issues

BACKGROUND: Racial disparities in outcomes are well described among surgical patients.

OBJECTIVE: The purpose of this work was to identify any racial disparities in the receipt of a minimally invasive approach for colorectal surgery.

DESIGN: Adults undergoing colorectal surgery were studied using the University HealthSystem Consortium. Univariate and multivariable analyses were used to identify predictors for the receipt of a minimally invasive approach.

SETTINGS: The study was conducted at academic hospitals and their affiliates.

PATIENTS: Adults ≥18 years of age who underwent surgery for colorectal cancer, diverticular disease, IBD, or benign colorectal tumor between 2008 and 2011 were included.

MAIN OUTCOME MEASURES: The receipt of a minimally invasive surgical approach was the main measured outcome.

RESULTS: A total of 82,474 adult patients met the study inclusion criteria. Of these, 69,664 (84%) were white, 10,874 (13%) were black, and 1936 (2%) were Asian. Blacks were younger, with higher rates of public insurance and higher comorbidity burden and baseline severity of illness compared with white and Asian patients. Black patients were less likely (adjusted OR = 0.83 (95% CI, 0.79–0.87)) and Asian patients more likely (adjusted OR = 1.34 (95% CI, 1.21–1.49)) than whites to receive minimally invasive surgery. This association did not change with stratification by insurance type (public or private). Black patients had higher rates of intensive care unit admission and nonhome discharge, as well as an increased length of stay compared with white and Asian patients. No differences in complications, readmission, or mortality rates were observed with minimally invasive surgery, but black patients were more likely to be readmitted or to die with open surgery.

LIMITATIONS: The study was limited by the retrospective nature of its data.

CONCLUSIONS: We identified racial differences in the receipt of a minimally invasive approach for colorectal surgery, regardless of insurance status, as well as improved outcomes for minority races who underwent a minimally invasive technique compared with open surgery. The improved outcomes associated with minimally invasive surgery should prompt efforts to increase rates of its use among black patients.

1 Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts

2 Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts

3 Division of Colorectal Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts

Financial Disclosure: None reported.

Correspondence: Rachelle N. Damle, M.D., M.S., University of Massachusetts, 55 Lake Ave, Room S3-752, Worcester, MA 01655. E-mail: rachelledamle@gmail.com

© 2016 The American Society of Colon and Rectal Surgeons