Racial Differences in Short-term Surgical Outcomes Following Surgery for Diverticulitis
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- Alavi, K., Cervera-Servin, J.A., Sturrock, P.R. et al. J Gastrointest Surg (2012) 16: 613. doi:10.1007/s11605-011-1787-0
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Diverticular disease ranks as one of the more common gastrointestinal disorders among westernized nations. Few studies have examined racial differences in the care and surgical outcomes of diverticulitis. The aim of this study was to determine if race is a predictor of peri-operative morbidity and mortality following surgery for diverticulitis.
The American College of Surgeons National Surgical Quality Improvement Program (2005–2008) was queried with the primary dependent variables being 30-day morbidity and mortality. Differences in morbidity and mortality between races were compared using χ2 and Student t tests. Logistic regression was used to calculate odds ratios for morbidity and mortality. To determine if the effect of race is modified by insurance status and case complexity, additional models were developed across age subgroups (<65 vs ≥65) and levels of case complexity.
We identified 4,709 white and 360 African American patients. Despite being younger (57.6 ± 0.74 vs 59 ± 0.2, p < 0.05), African Americans were more likely to present with hypertension, diabetes, renal failure, dependent functional status, American Society of Anesthesiology class ≥3 (all p < 0.0001) and were more likely to require urgent surgery (p < 0.05), intra-operative blood transfusions(p < 0.0001), and undergo open colectomy (p < 0.0001). On adjusted analysis, African American race emerged as an independent predictor of morbidity (p < 0.05) and mortality (p < 0.05), without differences across insurance categories and less complex procedures. African American race remained a strong predictor of morbidity in more complex procedures (p < 0.05).
African Americans undergoing surgery for diverticulitis are more likely to have associated co-morbidities, require urgent surgery, undergo open surgery, and are at increased risk of morbidity and mortality. These findings highlight a need to address the root cause for disparities in care and outcomes after surgery.