Surgical Endoscopy

, Volume 22, Issue 9, pp 1977–1986

Disparate use of minimally invasive surgery in benign surgical conditions

  • Rocco Ricciardi
  • Harry P. Selker
  • Nancy N. Baxter
  • Peter W. Marcello
  • Patricia L. Roberts
  • Beth A. Virnig
Article

DOI: 10.1007/s00464-008-0003-0

Cite this article as:
Ricciardi, R., Selker, H.P., Baxter, N.N. et al. Surg Endosc (2008) 22: 1977. doi:10.1007/s00464-008-0003-0

Abstract

Background

Disparities in outcome across race and ethnicity have been consistently described for medical and surgical care. Given that surgery is a rapidly evolving field, we hypothesized that racial disparities exist in access to minimally invasive surgery (MIS), which importantly influences outcome.

Methods

Cohort analysis of all patients who underwent appendectomy, gastric fundoplication, and gastric bypass in the Nationwide Inpatient Sample, a 20% stratified random sample of US hospital discharge abstracts. To determine the effect of race on the use of MIS techniques and morbidity and mortality, we controlled for patient characteristics, comorbidity, and hospital characteristics including surgical volume and MIS conversion to open surgery.

Results

Blacks were consistently less likely to be treated with MIS despite adjustment for socioeconomic status, comorbidity, and treatment setting. In addition, in-hospital mortality and complications such as pneumonia, heart disease, infections, and surgical misadventures were higher in black than white patients. These outcomes differences remained despite adjustment for hospital volume, the use of MIS, and MIS conversion to open surgery.

Conclusions

We demonstrate evidence of racial disparities in the use of MIS for benign surgical conditions and worse outcomes for patients of black race. Although, the racial differences in outcome were attenuated with adjustment for MIS, further studies are needed to help resolve remaining differences in outcomes across race.

Keywords

DisparityLaparoscopyTechniqueSurgeryRaceAccess

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Rocco Ricciardi
    • 1
    • 2
  • Harry P. Selker
    • 2
  • Nancy N. Baxter
    • 3
  • Peter W. Marcello
    • 1
  • Patricia L. Roberts
    • 1
  • Beth A. Virnig
    • 4
  1. 1.Department of Colon and Rectal SurgeryLahey Clinic, Tufts UniversityBurlingtonUSA
  2. 2.Institute for Clinical Research and Health Policy StudiesTufts UniversityBostonUSA
  3. 3.Department of Surgery and Li Ka Shing Knowledge InstituteSt. Michael’s Hospital, University of TorontoTorontoCanada
  4. 4.Division of Policy and ManagementUniversity of Minnesota School of Public HealthMinneapolisUSA