Kasey Leigh Wood1, Syed F Haider1, Anthony Bui1, I Michael Leitman2. 1. Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1076, New York, NY, 10029, USA. 2. Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1076, New York, NY, 10029, USA. Michael.Leitman@mssm.edu.
Abstract
BACKGROUND: Laparoscopy has become the standard of care for the majority of cases for inguinal hernia repair, cholecystectomy, appendectomy, and colectomy due to the shortened patient recovery time compared to open surgery. This study sought to determine if there exists racial disparity in access to a laparoscopic approach to these common surgeries. METHODS: This was an IRB-approved retrospective study utilizing data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Individuals who underwent inguinal hernia repair, cholecystectomy, appendectomy, and colectomy in 2016 were identified. Information on self-reported race and ethnicity and other demographic and pre-operative clinical covariates were recorded. Propensity matching was conducted to evaluate the association between race and a laparoscopic approach to surgery. RESULTS: There were 44,522, 60,444, 50,523, and 58,012 cases of inguinal hernia repair, cholecystectomy, appendectomy, and colectomy identified, respectively. Of these patients, 8.38, 8.76, 6.69, and 9.02% self-identified as black, respectively. Confounding effects of variables other than race were balanced by propensity matching. After propensity matching, there were 7460, 10,574, 10,470, and 6758 cases of hernia repair, cholecystectomy, colectomy, and appendectomy, respectively. On univariate (Chi square) analysis with laparoscopic surgery as the primary outcome, black race was significantly associated with lower likelihood of undergoing a minimally-invasive surgical approach in all four surgical procedures under investigation (33.86% of white patients and 21.69% of black patients, p < 0.0001 for hernia repair; 97.98% of white patients and 94.29%, p < 0.0001 of black patients for cholecystectomy; 70.93% of white patients and 48.60% of black patients, p < 0.0001 for colectomy; and 98.85% of white patients and 92.81% of black patients, p < 0.0001 for appendectomy). CONCLUSIONS: There appears to be a significant racial disparity in the application of a laparoscopic approach to routine intra-abdominal surgery. This warrants further investigation into the barriers preventing access to laparoscopic general surgical procedures that certain populations face.
BACKGROUND: Laparoscopy has become the standard of care for the majority of cases for inguinal hernia repair, cholecystectomy, appendectomy, and colectomy due to the shortened patient recovery time compared to open surgery. This study sought to determine if there exists racial disparity in access to a laparoscopic approach to these common surgeries. METHODS: This was an IRB-approved retrospective study utilizing data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Individuals who underwent inguinal hernia repair, cholecystectomy, appendectomy, and colectomy in 2016 were identified. Information on self-reported race and ethnicity and other demographic and pre-operative clinical covariates were recorded. Propensity matching was conducted to evaluate the association between race and a laparoscopic approach to surgery. RESULTS: There were 44,522, 60,444, 50,523, and 58,012 cases of inguinal hernia repair, cholecystectomy, appendectomy, and colectomy identified, respectively. Of these patients, 8.38, 8.76, 6.69, and 9.02% self-identified as black, respectively. Confounding effects of variables other than race were balanced by propensity matching. After propensity matching, there were 7460, 10,574, 10,470, and 6758 cases of hernia repair, cholecystectomy, colectomy, and appendectomy, respectively. On univariate (Chi square) analysis with laparoscopic surgery as the primary outcome, black race was significantly associated with lower likelihood of undergoing a minimally-invasive surgical approach in all four surgical procedures under investigation (33.86% of white patients and 21.69% of black patients, p < 0.0001 for hernia repair; 97.98% of white patients and 94.29%, p < 0.0001 of black patients for cholecystectomy; 70.93% of white patients and 48.60% of black patients, p < 0.0001 for colectomy; and 98.85% of white patients and 92.81% of black patients, p < 0.0001 for appendectomy). CONCLUSIONS: There appears to be a significant racial disparity in the application of a laparoscopic approach to routine intra-abdominal surgery. This warrants further investigation into the barriers preventing access to laparoscopic general surgical procedures that certain populations face.
Authors: Ethan Basch; John Spertus; R Adams Dudley; Albert Wu; Cynthia Chuahan; Perry Cohen; Mary Lou Smith; Nick Black; Amaris Crawford; Keri Christensen; Kathleen Blake; Christine Goertz Journal: Value Health Date: 2015-05-21 Impact factor: 5.725
Authors: Cornelia M Borkhoff; Gillian A Hawker; Hans J Kreder; Richard H Glazier; Nizar N Mahomed; James G Wright Journal: CMAJ Date: 2008-03-11 Impact factor: 8.262
Authors: Erik J DeAngelis; James A Zebley; Ikechukwu S Ileka; Sangrag Ganguli; Armon Panahi; Richard L Amdur; Khashayar Vaziri; Juliet Lee; Hope T Jackson Journal: Surg Endosc Date: 2022-06-22 Impact factor: 4.584
Authors: J D Bozzay; D A Nelson; D R Clifton; D B Edgeworth; P A Deuster; J D Ritchie; S R Brown; A J Kaplan Journal: Hernia Date: 2022-08-11 Impact factor: 2.920
Authors: Colby J Hyland; Ruby Guo; Ravi Dhawan; Manraj N Kaur; Paul A Bain; Maria O Edelen; Andrea L Pusic Journal: J Patient Rep Outcomes Date: 2022-03-07
Authors: Joon Y Park; Arjun Verma; Zachary K Tran; Michael A Mederos; Peyman Benharash; Mark Girgis Journal: Ann Surg Oncol Date: 2022-01-07 Impact factor: 5.344