Racial and ethnic variation in emergent surgical care and outcomes during the COVID-19 pandemic: post hoc analysis of an EAST MCT

Nolan M Winicki; Alden Dahan; Somiya Maheshwari; Brandon Crowley; Rondi Gelbard; Sigrid Burruss

doi:10.1136/tsaco-2022-001023

Racial and ethnic variation in emergent surgical care and outcomes during the COVID-19 pandemic: post hoc analysis of an EAST MCT

Trauma Surg Acute Care Open. 2022 Dec 9;7(1):e001023. doi: 10.1136/tsaco-2022-001023. eCollection 2022.

Authors

Nolan M Winicki^{1

2}, Alden Dahan^{1

2}, Somiya Maheshwari¹, Brandon Crowley³, Rondi Gelbard³, Sigrid Burruss²

Affiliations

¹ University of California Riverside School of Medicine, Riverside, California, USA.
² Department of Surgery, Loma Linda University Medical Center, Loma Linda, California, USA.
³ Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Abstract

Objectives: The COVID-19 pandemic highlighted concerns regarding the equity of medical care. We evaluated associations between race/ethnicity, timing of hospital presentation and outcomes of acute appendicitis (AP) and acute cholecystitis (AC) during the initial pandemic peak.

Methods: Analysis was performed on a prospective, observational, multicenter study of adults with AP or AC. Patients were categorized as pre-pandemic (pre-CoV: October 2019-January 2020) or during the first pandemic peak (CoV: April 2020 through 4 months following the end of local pandemic restrictions). Patient demographics, American Association for the Surgery of Trauma (AAST) imaging/pathology grade, duration of symptoms before triage, time from triage to intervention and hospital length of stay were collected.

Results: A total of 2165 patients (1496 pre-CoV, 669 CoV) were included from 19 centers. Asian and Hispanic patients with AC had a longer duration of symptoms prior to presentation during CoV than pre-CoV (100.6 hours vs 37.5 hours, p<0.01 and 85.7 hours vs 52.5 hours, p<0.05, respectively) and presented later during CoV than Black or White patients (34.3 and 37.9 hours, p<0.01). During CoV, Asian patients presented with higher AAST pathology grade for AP compared with pre-CoV (1.90 vs 1.26, p<0.01). Asian and Hispanic patients presented with higher AAST pathology grade for AC during CoV versus pre-CoV (2.57 vs 1.45, p<0.01, and 1.57 vs 1.20, p<0.05, respectively). Patients with AC and an AAST pathology grade of ≥3 were at higher odds of postoperative complications (OR 4.4, 95% CI 1.0 to 18.4) and AP (OR 2.8, 95% CI 1.3 to 6.0). Asian and Hispanic patients with AC had a higher risk of postoperative complications compared to White patients (Asian: OR 3.9, 95% CI 1.2 to 12.7; Hispanic: OR 3.3, 95% CI 1.2 to 8.9).

Conclusion: Asian and Hispanic patients had a longer duration of symptoms before hospital presentation during the initial COVID-19 peak, had higher odds of postoperative complications and more advanced pathologic disease.

Level of evidence: III, Prognostic/epidemiological.

Keywords: appendicitis; cholecystitis; healthcare disparities; healthcare quality, access, and evaluation.