Identifying population-level and within-hospital disparities in surgical care

Authors

Elzerie de Jage, University of Vermont,USA
Samia Y. Osman, Harvard Medical School,USA
Christina Sheu, James Cook University, Australia
Esther Moberg, Johns Hopkins University,USA
Jamie Ye Ye, University of Vermont,USA
Helen R. Burstin, Harvard Medical School,USA
David B. Hoyt, University of Vermont,USA
Andrew J Schoenfel J. Schoenfe, Harvard Medical School,USA
Clifford Y. Ko, Harvard Medical School,USA
Adil H. Haider, Aga Khan UniversityFollow

Document Type

Article

Department

Surgery

Abstract

Introduction: The lack of consensus on equity measurement and its incorporation into quality-assessment programs at the hospital and system levels may be a barrier to addressing disparities in surgical care. This study aimed to identify population-level and within-hospital differences in the quality of surgical care provision.
Methods: The analysis included 657 National Surgical Quality Improvement Program participating hospitals with over 4 million patients (2014-2018). Multi-level random slope, random intercept modeling was used to examine for population-level and in-hospital disparities. Disparities in surgical care by Area Deprivation Index (ADI), race, and ethnicity were analyzed for five measures: all-case inpatient mortality, all-case urgent readmission, all-case postoperative surgical site infection, colectomy mortality, and spine surgery complications.
Results: Population-level disparities were identified across all measures by ADI, two measures for Black race (all-case readmissions and spine surgery complications), and none for Hispanic ethnicity. Disparities remained significant in the adjusted models. Prior to risk-adjustment, in all measures examined, within-hospital disparities were detected in: 25.8-99.8% of hospitals for ADI, 0-6.1% of hospitals for Black race, and 0-0.8% of hospitals for Hispanic ethnicity. Following risk-adjustment, in all measures examined, fewer than 1.1% of hospitals demonstrated disparities by ADI, race, or ethnicity.
Conclusions: Following risk adjustment, very few hospitals demonstrated significant disparities in care. Disparities were more frequently detected by ADI than by race and ethnicity. The lack of substantial in-hospital disparities may be due to the use of postoperative metrics, small sample sizes, the risk adjustment methodology, and healthcare segregation. Further work should examine surgical access and healthcare segregation.

Comments

Volume, issue and pagination are not provided by author/publisher.

Publication (Name of Journal)

Journal of the American College of Surgeons

DOI

10.1097/XCS.0000000000001113

Recommended Citation

Jage, E. d., Osman, S. Y., Sheu, C., Moberg, E., Ye, J., Burstin, H. R., Hoyt, D. B., Schoenfe, A. J., Ko, C. Y., Haider, A. H. (2024). Identifying population-level and within-hospital disparities in surgical care. Journal of the American College of Surgeons.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_gen/482