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Racial Disparities in 30-Day Outcomes After Colorectal Surgery in an Integrated Healthcare System

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Racial disparities in colorectal surgery outcomes have been studied extensively in the USA, and access to healthcare resources may contribute to these differences. The Veterans Health Administration (VHA) is the largest integrated healthcare network in the USA with the potential for equal access care to veterans. The objective of this study is to evaluate the VHA for the presence of racial disparities in 30-day outcomes of patients that underwent colorectal resection.

Methods

Colon and rectal resections from 2008 to 2019 were reviewed retrospectively using the Veterans Affairs Surgical Quality Improvement Program database. Patients were categorized by race and ethnicity. Multivariable analysis was used to compare 30-day outcomes. Cases with “unknown/other/declined to answer” race/ethnicity were excluded.

Results

Thirty-six-thousand-nine-hundred-sixty-nine cases met inclusion criteria: 27,907 (75.5%) Caucasian, 6718 (18.2%) African American, 2047 (5.5%) Hispanic, and 290 (0.8%) Native American patients. There were no statistically significant differences in overall complication incidence or mortality between all cohorts. Compared to Caucasian race, African American patients had longer mean length of stay (10.7 days vs. 9.7 days; p < 0.001). Compared to Caucasian race, Hispanic patients had higher odds of pulmonary-specific complications (adjusted odds ratio with 95% confidence interval = 1.39 [1.17–1.64]; p < 0.001).

Conclusions

The VHA provides the benefits of integrated healthcare and access, which may explain the improvements in racial disparities compared to existing literature. However, some racial disparities in clinical outcomes still persisted in this analysis. Further efforts beyond healthcare access are needed to mitigate disparities in colorectal surgery.

Classifications

[Outcomes]; [Database]; [Veterans]; [Colorectal Surgery]; [Morbidity]; [Mortality].

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Authors and Affiliations

  1. Department of Surgery, Veterans Affairs Medical Center, 50 Irving St. NW, Washington, DC, 20422, USA

    Timothy J. Holleran, Michael A. Napolitano, Jessica B. LaPiano, Suzanne Arnott, Fredrick J. Brody & James E. Duncan

  2. Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA

    Timothy J. Holleran & Jessica B. LaPiano

  3. Department of Surgery, George Washington University Hospital, Washington, DC, USA

    Michael A. Napolitano, Suzanne Arnott & Richard L. Amdur

Authors
  1. Timothy J. Holleran
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  2. Michael A. Napolitano
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  3. Jessica B. LaPiano
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  4. Suzanne Arnott
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  5. Richard L. Amdur
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  6. Fredrick J. Brody
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  7. James E. Duncan
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Contributions

All listed authors contributed substantially to study conception and design, data acquisition, data analysis/interpretation, manuscript drafting, critical revisions, provided final approval of the version to be published and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to James E. Duncan.

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The authors declare no competing interests.

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Presentation

Accepted for oral presentation at the 2021 American College of Surgeons Clinical Congress, October 24th–28th.

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Cite this article

Holleran, T.J., Napolitano, M.A., LaPiano, J.B. et al. Racial Disparities in 30-Day Outcomes After Colorectal Surgery in an Integrated Healthcare System. J Gastrointest Surg 26, 433–443 (2022). https://doi.org/10.1007/s11605-021-05151-6

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  • DOI: https://doi.org/10.1007/s11605-021-05151-6

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