Study identifies racial and ethnic disparities in surgical care

Minority patients in New York City are less likely than whites to have procedures performed by surgeons or at facilities that have handled large numbers of similar procedures in the past, according to a recent report in the Archives of Surgery.

Andrew J. Epstein, PhD, of the School of Public Health at Yale University, and his colleagues selected 10 procedures, including cancer, cardiovascular and orthopedic surgeries, for which published evidence indicates hospital and surgeon volume influences patients’ short-term risk of death. They then studied 133,821 patients in the New York City area who underwent one of these procedures between 2001 and 2004.

They calculated the annual procedure volumes for each hospital and surgeon using a statewide database, and determined thresholds for high-volume vs. low-volume providers and facilities based on published research.

Of the patients, 75.3% were white, 13.1% were black, 3.2% were Asian and 8.4% were Hispanic. For all 10 procedures, white patients were more frequently treated by high-volume surgeons and at high-volume facilities when compared with black, Asian or Hispanic patients.

“Even after adjusting for a broad range of relevant factors, compared with white patients, treatment at high-volume hospitals by high-volume surgeons was lower by 11.8% for black patients, 8% for Asian patients and 7% for Hispanic patients on average across the 10 study procedures,” the authors wrote.

They noted that the proposed systematic barriers – including geography and financial incentives keeping minority patients from higher-quality providers were mitigated by their decision to focus on the New York City Metropolitan area and control for a range of variables that could affect which providers were used.

“An important study”

“In general, this is an important study which examines previously less-investigated issues regarding racial variations in where patients get surgical care,” S.A. Ibrahim, MD, MPH, the Associate Chief of Staff for Medicine with the Veterans Affairs Medical Center in Philadelphia, told Endocrine Today. “These findings raise questions about access to high-quality surgical care for minority patients and may explain in part why minority patients – particularly African-American patients – express low preference for joint replacement.”

Ibrahim added “The study is limited by several things, including the fact that it excluded about 15% of the sample because data on race was either missing or inaccurate.”

The authors concluded that efforts could be made among providers, policymakers and clinicians to help encourage minority patients to consider comparative performance information when choosing hospitals and surgeons.

“Making sure that minority patients have good outcomes after joint replacement may help reduce the marked racial disparity in the access and utilization of this effective treatment,” Ibrahim said.

Epstein AJ. Arch Surg.2010; 145:179-186.