Racial Disparities in the Care of Acute Cholecystitis: A National Study
Department of Surgery
Medical Subject Headings
Cholecystitis, Acute; Healthcare Disparities; Continental Population Groups
Life Sciences | Medicine and Health Sciences
Introduction: Racial differences in utilization and outcomes of major surgical procedures have been shown previously. We sought to investigate whether racial disparities exist in common diseases like acute cholecystitis (AC).
Methods: Discharge records (Nationwide Inpatient Sample) for all adult admissions (n = 205,119) with a primary diagnosis of AC from 1998 to 2006 were examined. A cohort of only white and black patients was created. Covariates included other patient demographics, comorbidities, and hospital characteristics. Separate logistic regression models were created to identify areas of disparity in clinical care.
Results: 86.0% of patients received a cholecystectomy; 89.9% were laparoscopic (LC). 22,308 (10.9%) were identified as black. Compared with white patients, black patients tended to be female (74.5% vs 58.7%), have Medicaid insurance (19.1% vs 6.2%), lower income (82.4% vs 66.8%), and have more than 1 comorbidity (69.3% vs 65.6%) (p < 0.0001). After adjusting for hospital and patient factors, black patients were less likely to receive a cholecystectomy (odds ratio [OR], 0.70). For those who did, blacks were less likely to receive LC (OR, 0.70) and underwent open conversion more often (OR, 1.23). Blacks were also more likely to experience a postoperative complication (OR, 1.17), have a prolonged LOS (OR, 1.73), and more likely to die during the hospital stay when compared with white patients (OR, 1.37; 95% confidence interval, 1.17 to 1.59).
Conclusions: Our findings raise concerns about the delivery of care and outcomes for black compared with white patients with common surgical diseases like AC. Future studies should investigate possible social, biologic, and economic reasons for these disparities.
Presented at the 64th Annual Sessions of the Owen H Wangensteen Forum on Fundamental Surgical Problems, The American College of Surgeons 94th Annual Clinical Congress, 2009.
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Citation: Journal of the American College of Surgeons, Volume 209, Issue 3, Supplement 1, September 2009, Page S98.
Singla, Anand; Murphy, Melissa M.; Ng, Sing Chau; Li, Youfu; Tseng, Jennifer F.; and Shah, Shimul A., "Racial Disparities in the Care of Acute Cholecystitis: A National Study" (2009). University of Massachusetts Medical School. Senior Scholars Program. Paper 102.