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Treatment Utilization and Socioeconomic Disparities in the Surgical Management of Gastroparesis

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Gastroparesis is an end-organ sequela of diabetes. We evaluated the roles of race and socioeconomic status in hospitalization rates and utilization of surgical treatments in these patients.

Methods

Data was extracted from the National Inpatient Sample (NIS) between the years 2012 and 2014, and any discharge diagnosis of gastroparesis (536.3) was included. Gastrostomy, jejunostomy, and total parenteral nutrition were considered nutritional support procedures, and procedures aimed at improving motility were considered definitive disease-specific procedures: pyloroplasty, endoscopic pyloric dilation, gastric pacemaker placement, and gastrectomy.

Results

There were 747,500 hospitalizations reporting a discharge diagnosis of gastroparesis. On multivariable analysis, black race (OR 1.93, 95% CI 1.89–1.98; p < 0.001) and Medicaid insurance (OR 1.46, 95% CI 1.42–1.50; p < 0.001) were the strongest socioeconomic risk factors for hospitalization due to gastroparesis. Patients in urban teaching institutions were most likely to undergo a surgical intervention for gastroparesis (5.53% of patients versus 3.94% of patients treated in urban non-teaching hospitals and 2.38% of patients in rural hospitals; p < 0.001). Uninsured patients were less than half as likely to receive treatment compared to those with private insurance (OR 0.41, 95% CI 0.34–0.48; p < 0.001), and black patients had an OR 0.75 (95% CI 0.69–0.81; p < 0.001) for receiving treatment. Urban teaching hospitals had a twofold higher likelihood of intervention (OR 2.12, 95% CI 1.84–2.44; p < 0.001).

Conclusions

Marked racial and economic disparities exist in surgical distribution of care for gastroparesis, potentially driven by differences in utilization of care.

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Funding

This study was internally funded.

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Authors and Affiliations

  1. Department of Surgery, New York Presbyterian Hospital – Weill Cornell Medicine, 525 East 68th St, Box 294, New York, NY, 10065, USA

    Katherine D. Gray, Timothy M. Ullmann, Adham Elmously, Toni Beninato, Thomas J. Fahey III, Alfons Pomp, Rasa Zarnegar & Cheguevara Afaneh

Authors
  1. Katherine D. Gray
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  2. Timothy M. Ullmann
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  3. Adham Elmously
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  4. Toni Beninato
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  8. Cheguevara Afaneh
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All authors contributed to the conception, design, or data analysis of this work; contributed to drafting or critical revision of the intellectual content of this work; and give final approval of the version to be published. All authors agree to be accountable for this work.

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Correspondence to Cheguevara Afaneh.

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Gray, K.D., Ullmann, T.M., Elmously, A. et al. Treatment Utilization and Socioeconomic Disparities in the Surgical Management of Gastroparesis. J Gastrointest Surg 24, 1795–1801 (2020). https://doi.org/10.1007/s11605-019-04294-x

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  • DOI: https://doi.org/10.1007/s11605-019-04294-x

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