Racial Disparities in Emergency General Surgery: Do Differences in Outcomes Persist Among Universally-Insured Military Patients?

Presenters/Authors

Cheryl K. Zogg, Brigham and Women's Hospital
Wei Jiang, Brigham and Women’s HospitalFollow
Muhammed Ali Chaudhary, Brigham and Women’s HospitalFollow
Adil A. Shah, Brigham and Women’s HospitalFollow
Stuart R. Lipsitz, Brigham and Women's HospitalFollow
Joel S. Weissman, Brigham and Women’s Hospital
Zara Cooper, Brigham and Women's HospitalFollow
Ali Salim, Brigham and Women's HospitalFollow
Stephanie L. Nitzschke, Brigham and Women's HostpitalFollow
Louis L. Nguyen, Brigham and Women's Hostpital
Lorens A. Helmchen, George Washington UniversityFollow
Linda G. Kimsey, Georgia Southern University, Jiann-Ping Hsu College of Public HealthFollow
Samuel Olaiya, Uniformed Services University of the Health SciencesFollow
Peter A. Learn, Uniformed Services University of the Health Sciences
Adil H. Haider, Brigham and Woman's HospitalFollow

Document Type

Presentation

Presentation Date

9-9-2015

Abstract or Description

Introduction: Racial disparities in outcomes among emergency general surgery (EGS) patients are well described. As many minority patients are also uninsured, increasing access to care is thought to be a viable policy solution to mitigate these inequities. The objective of this study was to determine whether racial disparities in in-hospital, 30- and 90-day outcomes exist within a universally-insured population of military EGS patients.

Methods: Five years (2006-2010) of TRICARE (which provides universal insurance coverage to active/reserve/retired members of the US Armed Services and their dependents) data were queried. Adults (≥18y) with a primary EGS condition (as defined by AAST criteria) were included. Racial differences in demographic and clinical characteristics were compared using descriptive statistics. Risk-adjusted multilevel logistic regression, accounting for clustering of patients within hospitals was used to assess race-associated differences in in-hospital mortality and in mortality, major morbidity (pneumonia, PE, renal failure, UTI, CVA, MI, cardiac arrest, ARDS, sepsis, septic shock) and readmission rates at 30 and 90 days.

Results: Over the 5 years studied, 122,115 EGS patients were identified, of whom, 73.4% were White, 14.4% were Black, and 4.6% were of Asian/Pacific Islander (PI) descent. The largest population subgroups were active-duty (36.4%), males (55.5%), aged 45-64y (36.1%). Overall outcomes by race are presented (Table). Racial differences stratified by EGS diagnostic group, operative vs. non-operative technique, and direct (military hospitals) vs. purchased care (civilian hospitals) revealed similar trends.

Conclusion: Racial differences in surgical outcomes among universally-insured military EGS patients were largely not found; although, some disparities remain. This profound contrast with civilian data, will help to inform policy with the Department of Defense and disparities interventions nationwide, attesting to important differences potentially related to insurance, access to care, and military cultures and values.

Sponsorship/Conference/Institution

American Association for the Surgery of Trauma Annual Meeting (AAST)

Location

Las Vegas, NV

Recommended Citation

Zogg, Cheryl K., Wei Jiang, Muhammed Ali Chaudhary, Adil A. Shah, Stuart R. Lipsitz, Joel S. Weissman, Zara Cooper, Ali Salim, Stephanie L. Nitzschke, Louis L. Nguyen, Lorens A. Helmchen, Linda G. Kimsey, Samuel Olaiya, Peter A. Learn, Adil H. Haider. 2015. "Racial Disparities in Emergency General Surgery: Do Differences in Outcomes Persist Among Universally-Insured Military Patients?." Department of Health Policy and Community Health Faculty Presentations. Presentation 96.
https://digitalcommons.georgiasouthern.edu/hpmb-facpres/96