Disparities in unplanned surgery amongst medicare beneficiaries - 16/03/23

Doi : 10.1016/j.amjsurg.2022.08.018

Valeria S.M. Valbuena ^a,^b,^c,^⁎ , Shukri H.A. Dualeh ^a,^c, Nicholas Kunnath ^c, Justin B. Dimick ^a,^c, Andrew M. Ibrahim ^a,^c,^d
^a University of Michigan, Department of Surgery, Ann Arbor, MI, USA
^b University of Michigan, National Clinician Scholars Program, Ann Arbor, MI, USA
^c University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA
^d University of Michigan, Taubman College of Architecture & Urban Planning, USA

^∗Corresponding author. 1500 East Medical Center Drive 2110 Taubman Center, SPC 5346, Ann Arbor, MI, 48109, USA.1500 East Medical Center Drive 2110 Taubman CenterSPC 5346Ann ArborMI48109USA

Abstract

Background

While significant efforts have been made to understand surgical disparities for procedures that are performed in either the elective or unplanned settings, far less is known about procedures performed in both settings.

Methods

Cross-sectional study of 1,135,743 Medicare beneficiaries undergoing incisional hernia repair, colectomy, or abdominal aortic aneurysm repair between 2014 and 2018. Risk-adjusted outcomes were assessed using multivariable logistic regression.

Results

Compared to White beneficiaries, unplanned surgery rates were higher for Black (44.0%vs38.8%, OR = 1.29,p < 0.001) and Asian beneficiaries(40.4%vs38.8%,OR = 1.09,p < 0.001). While there were minimal differences in 30-day mortality for elective procedures, unplanned procedures demonstrated wider disparities (Black vs White 12.4%vs11.3%,OR = 1.11,p < 0.001; Asian vs White 13.2%vs11.3%,OR = 1.18,p < 0.001). Similar patterns were observed for readmissions.

Conclusions

Unplanned procedures are more common and demonstrate wider disparities in outcomes among minority Medicare beneficiaries. Reducing unplanned surgery rates among these groups may be an effective strategy to limit overall disparities in postoperative outcomes.

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Highlights

•	Unplanned surgery is more common among minoritized Medicare beneficiaries.
•	Mortality and readmissions increase for Asian & Black patients after unplanned surgery.
•	Reducing rates of unplanned surgery may mitigate overall surgical disparities.

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Keywords : Unplanned, Disparities, Outcomes