Race and surgical outcomes: It is not all black and white

Nestor F. Esnaola, Bruce L. Hall, Patrick W. Hosokawa, John Z. Ayanian, William G. Henderson, Shukri F. Khuri, Michael J. Zinner, Selwyn O. Rogers

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: Studies using Medicare data have suggested that African American race is an independent predictor of death after major surgery. We hypothesized that the apparent adverse effect of race on surgical outcomes is due to confounding by comorbidity, not race itself. Methods: We identified all non-Hispanic white and African American general surgery, private sector patients included in the National Surgery Quality Improvement Program (NSQIP) Patient Safety in Surgery Study (2001-2004). Patient characteristics, comorbidities, and postoperative outcomes were collected/analyzed using NSQIP methodology. Characteristics between races were compared using Student t and χ tests. Odds ratios (OR) for 30-day morbidity and mortality were calculated using multivariable logistic regression. Results: We identified 34,141 white and 5068 African American patients. African Americans were younger but more likely to undergo emergency surgery and present with hypertension, dyspnea, diabetes, renal failure, open wounds/infection, or advanced American Society of Anesthesiology class (all P < 0.001). African Americans underwent less complex procedures but had higher unadjusted 30-day morbidity (14.33% vs. 12.35%; P < 0.001) and mortality (2.09% vs. 1.65%; P = 0.02). After controlling for comorbidity, African American race had no independent effect on mortality (OR 0.95, (0.74-1.23)) but was associated with a higher risk of postoperative cardiac arrest (OR 2.49, (1.80-3.45)) and renal insufficiency/failure (OR 1.70 (1.32-2.18)). Conclusion: African American race is associated with greater comorbidity and cardiac/renal complications but is not an independent predictor of perioperative mortality after general surgery. Efforts to improve postoperative outcomes in African Americans should focus on reducing the need for emergency surgery and improving perioperative management of comorbid conditions.

Original languageEnglish (US)
Pages (from-to)647-654
Number of pages8
JournalAnnals of Surgery
Volume248
Issue number4
DOIs
StatePublished - Oct 2008
Externally publishedYes

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African Americans
Comorbidity
Odds Ratio
Renal Insufficiency
Mortality
Quality Improvement
Emergencies
Morbidity
Anesthesiology
Private Sector
hydroquinone
Wound Infection
Patient Safety
Medicare
Heart Arrest
Dyspnea
Logistic Models
Students
Hypertension
Kidney

ASJC Scopus subject areas

  • Surgery

Cite this

Esnaola, N. F., Hall, B. L., Hosokawa, P. W., Ayanian, J. Z., Henderson, W. G., Khuri, S. F., ... Rogers, S. O. (2008). Race and surgical outcomes: It is not all black and white. Annals of Surgery, 248(4), 647-654. https://doi.org/10.1097/SLA.0b013e31818a159a

Race and surgical outcomes : It is not all black and white. / Esnaola, Nestor F.; Hall, Bruce L.; Hosokawa, Patrick W.; Ayanian, John Z.; Henderson, William G.; Khuri, Shukri F.; Zinner, Michael J.; Rogers, Selwyn O.

In: Annals of Surgery, Vol. 248, No. 4, 10.2008, p. 647-654.

Research output: Contribution to journalArticle

Esnaola, NF, Hall, BL, Hosokawa, PW, Ayanian, JZ, Henderson, WG, Khuri, SF, Zinner, MJ & Rogers, SO 2008, 'Race and surgical outcomes: It is not all black and white', Annals of Surgery, vol. 248, no. 4, pp. 647-654. https://doi.org/10.1097/SLA.0b013e31818a159a
Esnaola NF, Hall BL, Hosokawa PW, Ayanian JZ, Henderson WG, Khuri SF et al. Race and surgical outcomes: It is not all black and white. Annals of Surgery. 2008 Oct;248(4):647-654. https://doi.org/10.1097/SLA.0b013e31818a159a
Esnaola, Nestor F. ; Hall, Bruce L. ; Hosokawa, Patrick W. ; Ayanian, John Z. ; Henderson, William G. ; Khuri, Shukri F. ; Zinner, Michael J. ; Rogers, Selwyn O. / Race and surgical outcomes : It is not all black and white. In: Annals of Surgery. 2008 ; Vol. 248, No. 4. pp. 647-654.
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