Differences in outcomes by race/ethnicity after thoracic surgery in a large integrated health system

Kian C Banks; Julia Wei; Leyda Marrero Morales; Zeuz A Islas; Nathan J Alcasid; Cynthia J Susai; Angela Sun; Katemanee Burapachaisri; Ashish R Patel; Simon K Ashiku; Jeffrey B Velotta

doi:10.1016/j.sopen.2024.04.002

Differences in outcomes by race/ethnicity after thoracic surgery in a large integrated health system

Surg Open Sci. 2024 Apr 15:19:118-124. doi: 10.1016/j.sopen.2024.04.002. eCollection 2024 Jun.

Authors

Kian C Banks^{1

2}, Julia Wei³, Leyda Marrero Morales⁴, Zeuz A Islas⁵, Nathan J Alcasid^{1

2}, Cynthia J Susai^{1

2}, Angela Sun³, Katemanee Burapachaisri⁴, Ashish R Patel^{1

2}, Simon K Ashiku^{1

2}, Jeffrey B Velotta^{1

2

4

5}

Affiliations

¹ Division of Thoracic Surgery, Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA 94611, USA.
² Department of Surgery, University of California, San Francisco- East Bay, 1411 E 31st St, Oakland, CA 94602, USA.
³ Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
⁴ University of California, San Francisco, School of Medicine, 533 Parnassus Ave, San Francisco, CA 94143, USA.
⁵ Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S Los Robles Ave, Pasadena, CA 91101, USA.

Abstract

Background: Disparities exist throughout surgery. We aimed to assess for racial/ethnic disparities among outcomes in a large thoracic surgery patient population.

Methods: We reviewed all thoracic surgery patients treated at our integrated health system from January 1, 2016-December 31, 2020. Post-operative outcomes including length of stay (LOS), 30-day return to the emergency department (30d-ED), 30-day readmission, 30- and 90-day outpatient appointments, and 30- and 90-day mortality were compared by race/ethnicity. Bivariate analyses and multivariable logistic regression were performed. Our multivariable models adjusted for age, sex, body mass index, Charlson Comorbidity Index, surgery type, neighborhood deprivation index, insurance, and home region.

Results: Of 2730 included patients, 59.4 % were non-Hispanic White, 15.0 % were Asian, 11.9 % were Hispanic, 9.6 % were Black, and 4.1 % were Other. Median (Q1-Q3) LOS (in hours) was shortest among non-Hispanic White (37.3 (29.2-76.1)) and Other (36.5 (29.3-75.4)) patients followed by Hispanic (46.8 (29.9-78.1)) patients with Asian (51.3 (30.7-81.9)) and Black (53.7 (30.6-101.6)) patients experiencing the longest LOS (p < 0.01). 30d-ED rates were highest among Hispanic patients (21.3 %), followed by Black (19.2 %), non-Hispanic White (18.1 %), Asian (13.4 %), and Other (8.0 %) patients (p < 0.01). On multivariable analysis, Hispanic ethnicity (Odds Ratio (OR) 1.43 (95 % CI 1.03-1.97)) and Medicaid insurance (OR 2.37 (95 % CI 1.48-3.81)) were associated with higher 30d-ED rates. No racial/ethnic disparities were found among other outcomes.

Conclusions: Despite parity across multiple surgical outcomes, disparities remain related to patient encounters within our system. Health systems must track such disparities in addition to standard clinical outcomes.

Key message: While our large integrated health system has been able to demonstrate parity across many major surgical outcomes among our thoracic surgery patients, race/ethnicity disparities persist including in the number of post-operative return trips to the emergency department. Tracking outcome disparities to a granular level such as return visits to the emergency department and number of follow up appointments is critical as health systems strive to achieve equitable care.

Keywords: Disparities; Outcomes; Race/ethnicity; Thoracic surgery.