TY - JOUR
T1 - Race-based differences in length of stay among patients undergoing pancreatoduodenectomy
AU - Schneider, Eric B.
AU - Calkins, Keri L.
AU - Weiss, Matthew J.
AU - Herman, Joseph M.
AU - Wolfgang, Christopher L.
AU - Makary, Martin A.
AU - Ahuja, Nita
AU - Haider, Adil H.
AU - Pawlik, Timothy M.
PY - 2014/9
Y1 - 2014/9
N2 - Background Race-based disparities in operative morbidity and mortality have been demonstrated for various procedures, including pancreatoduodenectomy (PD). Race-based differences in hospital length-of-stay (LOS), especially related to provider volume at the surgeon and hospital level, remain poorly defined. Methods Using the 2003-2009 Nationwide Inpatient Sample, we determined year-specific PD volumes for surgeons and hospitals and grouped them into terciles. Patient race (white, black, or Hispanic), age, sex, and comorbidities were examined. Median length of stay was calculated, and multivariable logistic regression was used to examine factors associated with increased LOS. Results Among 4,319 eligible individuals, 3,502 (81.1%) were white, 423 (9.8%) were black, and 394 (9.1%) were Hispanic. Overall median LOS was 12 days (range, 0-234). Median annual surgeon volume was 8 (interquartile range [IQR], 2-19; range, 1-54). Annual hospital volume ranged from 1 to 129 (median, 19; IQR, 7-55). White patients were more likely to have been treated at medium- to high-volume hospitals (odds ratio [OR] 1.53, P <.001) and by medium- to high-volume surgeons (OR 1.62, P <.001) than black or Hispanic patients. After PD, white, black, and Hispanic patients demonstrated similar in-hospital mortality (5.1%, 5.7% and 7.2% respectively P =.250). After adjustment, black (OR 1.36, P =.010) and Hispanic (OR 1.68, P <.001) patients were more likely to have a greater LOS after PD. Conclusion Black and Hispanic PD patients were less likely than white patients to be treated at higher-volume hospitals and by higher-volume surgeons. Proportional mortality and LOS after PD were greater among black and Hispanic patients.
AB - Background Race-based disparities in operative morbidity and mortality have been demonstrated for various procedures, including pancreatoduodenectomy (PD). Race-based differences in hospital length-of-stay (LOS), especially related to provider volume at the surgeon and hospital level, remain poorly defined. Methods Using the 2003-2009 Nationwide Inpatient Sample, we determined year-specific PD volumes for surgeons and hospitals and grouped them into terciles. Patient race (white, black, or Hispanic), age, sex, and comorbidities were examined. Median length of stay was calculated, and multivariable logistic regression was used to examine factors associated with increased LOS. Results Among 4,319 eligible individuals, 3,502 (81.1%) were white, 423 (9.8%) were black, and 394 (9.1%) were Hispanic. Overall median LOS was 12 days (range, 0-234). Median annual surgeon volume was 8 (interquartile range [IQR], 2-19; range, 1-54). Annual hospital volume ranged from 1 to 129 (median, 19; IQR, 7-55). White patients were more likely to have been treated at medium- to high-volume hospitals (odds ratio [OR] 1.53, P <.001) and by medium- to high-volume surgeons (OR 1.62, P <.001) than black or Hispanic patients. After PD, white, black, and Hispanic patients demonstrated similar in-hospital mortality (5.1%, 5.7% and 7.2% respectively P =.250). After adjustment, black (OR 1.36, P =.010) and Hispanic (OR 1.68, P <.001) patients were more likely to have a greater LOS after PD. Conclusion Black and Hispanic PD patients were less likely than white patients to be treated at higher-volume hospitals and by higher-volume surgeons. Proportional mortality and LOS after PD were greater among black and Hispanic patients.
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U2 - 10.1016/j.surg.2014.04.004
DO - 10.1016/j.surg.2014.04.004
M3 - Article
C2 - 24973128
AN - SCOPUS:84907597717
SN - 0039-6060
VL - 156
SP - 528
EP - 537
JO - Surgery (United States)
JF - Surgery (United States)
IS - 3
ER -