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Abella MKIL, Lee AY, Agonias K, Maka P, Ahn HJ, Woo RK. Racial Disparities in General Surgery Outcomes. J Surg Res 2023; 288:261-268. [PMID: 37030184 DOI: 10.1016/j.jss.2023.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/21/2023] [Accepted: 03/09/2023] [Indexed: 04/10/2023]
Abstract
INTRODUCTION While disparities in Black and Hispanic and Latino patients undergoing general surgeries are well described, most analyses leave out Asian, American Indian or Alaskan Native (AIAN), and native Hawaiian or Pacific Islander patients. This study identified general surgery outcomes for each racial group in the National Surgical Quality Improvement Program. METHODS National Surgical Quality Improvement Program was queried to identify all procedures conducted by a general surgeon from 2017 to 2020 (n = 2,664,197). Multivariable regression models were used to investigate the impact of race and ethnicity on 30-day mortality, readmission, reoperation, major and minor medical complications, and non-home discharge destinations. Adjusted odds ratios (AOR) and 95% confidence intervals were calculated. RESULTS Compared to non-Hispanic White patients, Black patients had higher odds of readmission and reoperation, and Hispanic and Latino patients had higher odds of major and minor complications. AIAN patients had higher odds of mortality (AOR: 1.003 (1.002-1.005), P < 0.001), major complication (AOR: 1.013 (1.006-1.020), P < 0.001), reoperation (AOR: 1.009, (1.005-1.013), P < 0.001), and non-home discharge destination (AOR: 1.006 (1.001-1.012), P = 0.025), while native Hawaiian or Pacific Islander patients had lower odds of readmission (AOR: 0.991 (0.983-0.999), P = 0.035) and non-home discharge destination (AOR: 0.983 (0.975-0.990), P < 0.001) compared to non-Hispanic White patients. Asian patients had lower odds of each adverse outcome. CONCLUSIONS Black, Hispanic and Latino, and AIAN patients are at higher odds for poor postoperative results than non-Hispanic White patients. AIANs had some of the highest odds of mortality, major complications, reoperation, and non-home discharge. Social health determinants and policy adjustments must be targeted to ensure optimal operative results for all patients.
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Affiliation(s)
| | - Anson Y Lee
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Keinan Agonias
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Piueti Maka
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Hyeong Jun Ahn
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Russell K Woo
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii; Kapi'olani Medical Center for Women and Children, Hawai'i Pacific Health, Honolulu, Hawaii
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Resad Ferati S, Parisien RL, Joslin P, Knapp B, Li X, Curry EJ. Socioeconomic Status Impacts Access to Orthopaedic Specialty Care. JBJS Rev 2022; 10:01874474-202202000-00007. [PMID: 35171876 DOI: 10.2106/jbjs.rvw.21.00139] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
» Financial, personal, and structural barriers affect access to all aspects of orthopaedic specialty care. » Disparities in access to care are present across all subspecialties of orthopaedic surgery in the United States. » Improving timely access to care in orthopaedic surgery is crucial for both health equity and optimizing patient outcomes. » Options for improving orthopaedic access include increasing Medicaid/Medicare payments to physicians, providing secondary resources to assist patients with limited finances, and reducing language barriers in both clinical care and patient education.
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Affiliation(s)
- Sehar Resad Ferati
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Robert L Parisien
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Patrick Joslin
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Brock Knapp
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Emily J Curry
- Boston University School of Public Health, Boston, Massachusetts
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Pastrana Del Valle J, Mahvi DA, Fairweather M, Wang J, Clancy TE, Ashley SW, Urman RD, Whang EE, Gold JS. Associations of gender, race, and ethnicity with disparities in short-term adverse outcomes after pancreatic resection for cancer. J Surg Oncol 2021; 125:646-657. [PMID: 34786728 DOI: 10.1002/jso.26748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/03/2021] [Accepted: 10/25/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Several studies have identified disparities in pancreatic cancer treatment associated with gender, race, and ethnicity. There are limited data examining disparities in short-term adverse outcomes after pancreatic resection for cancer. The aim of this study is to evaluate associations of gender, race, and ethnicity with morbidity and mortality after pancreatic resection for malignancy. METHODS The American College of Surgeons National Surgical Quality Improvement database was retrospectively reviewed. The χ2 test and Student's t-test were used for univariable analysis and hierarchical logistic regression for multivariable analysis. RESULTS Morbidity and major morbidity after pancreaticoduodenectomy are associated with male gender, Asian race, and Hispanic ethnicity, whereas 30-day mortality is associated with the male gender. Morbidity and major morbidity after distal pancreatectomy are associated with the male gender. Morbidity after pancreaticoduodenectomy is independently associated with male gender, Asian race, and Hispanic ethnicity; major morbidity is independently associated with male gender and Asian race, and mortality is independently associated with Hispanic ethnicity. CONCLUSIONS Gender, race, and ethnicity are independently associated with morbidity after pancreaticoduodenectomy for cancer; gender and race are independently associated with major morbidity; and ethnicity is independently associated with mortality. Further studies are warranted to determine the basis of these associations.
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Affiliation(s)
- Jonathan Pastrana Del Valle
- Department of Surgical Service, VA Boston Healthcare System, West Roxbury, Massachusetts, USA.,Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - David A Mahvi
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mark Fairweather
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jiping Wang
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Thomas E Clancy
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Stanley W Ashley
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Richard D Urman
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Edward E Whang
- Department of Surgical Service, VA Boston Healthcare System, West Roxbury, Massachusetts, USA.,Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jason S Gold
- Department of Surgical Service, VA Boston Healthcare System, West Roxbury, Massachusetts, USA.,Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Alhatem A, Quinn PL, Xia W, Chokshi RJ. Pancreatic Carcinosarcoma Clinical Outcome Analysis of the National Cancer Institute Database. J Surg Res 2020; 259:62-70. [PMID: 33279845 DOI: 10.1016/j.jss.2020.11.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 10/19/2020] [Accepted: 11/01/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pancreatic carcinosarcomas (PCS) are rare aggressive biphasic malignancies with a poor prognosis. We aimed to improve the understanding of PCS by analyzing variables that influence the mortality of PCS patients. METHODS The Surveillance, Epidemiology, and End Results database was queried for cases of PCS from 1973 to 2016. Cases were analyzed for patient demographics, tumor characteristics, and surgical intervention. Kaplan-Meier and Cox regression analyses were applied to investigate the overall survival (OS) and prognostic factors. RESULTS Thirty-nine cases of PCS were identified along with the disease demographics and characteristics. The majority of patients had a regionally invasive or metastatic disease. There was a significant decrease in OS with the increase of the tumor extension. Conversely, surgery showed to improve OS in the crude analysis, including patients that underwent lymphadenectomy. In addition, the unadjusted Cox regression results showed decreased hazard ratios with a local disease versus distant metastasis and with cancer-directed surgery versus no surgery. Nevertheless, the adjusted Cox regression results revealed that metastatic disease was the only significant predictor of survival. CONCLUSIONS This population-based study provides some insight to a very rare disease by analyzing 39 cases of PCS. Our finding suggests considering PCS as a nonsurgical disease and reserving surgery solely for patients with a localized disease in combination or after neoadjuvant therapy. Consequently, there is a need to further investigate novel therapies for this aggressive malignancy.
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Affiliation(s)
- Albert Alhatem
- Rutgers New Jersey Medical School, Newark, New Jersey; Department of Pathology, Immunology and Laboratory Medicine, University Hospital, Newark, New Jersey
| | - Patrick L Quinn
- Rutgers New Jersey Medical School, Newark, New Jersey; Division of Surgical Oncology, Department of Surgery, University Hospital, Newark, New Jersey
| | - Weiyi Xia
- Biostatistics and Epidemiology Services Center, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey
| | - Ravi J Chokshi
- Rutgers New Jersey Medical School, Newark, New Jersey; Division of Surgical Oncology, Department of Surgery, University Hospital, Newark, New Jersey.
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