de Jager, Elzerie, Osman, Samia Y., Sheu, Christina, Moberg, Esther, Ye, Jamie, Liu, Yaoming, Cohen, Mark E., Burstin, Helen R., Hoyt, David B., Schoenfeld, Andrew J., Haider, Adil H., Ko, Clifford, Maggard-Gibbons, Melinda A., Weissman, Joel S., and Britt, L.D. (2024) Identifying Population-Level and Within-Hospital Disparities in Surgical Care. Journal of the American College of Surgeons, 239. pp. 223-233.

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Abstract

BACKGROUND: 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.

STUDY DESIGN: The analysis included 657 NSQIP participating hospitals with more than 4 million patients (2014 to 2018). Multilevel 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 5 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, 2 measures for Black race (all-case readmissions and spine surgery complications), and none for Hispanic ethnicity. Disparities remained significant in the adjusted models. Before risk adjustment, in all measures examined, within-hospital disparities were detected in: 25.8% to 99.8% of hospitals for ADI, 0% to 6.1% of hospitals for Black race, and 0% to 0.8% of hospitals for Hispanic ethnicity. After risk adjustment, in all measures examined, less than 1.1% of hospitals demonstrated disparities by ADI, race, or ethnicity.

CONCLUSIONS: After 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.

Item ID:	85475
Item Type:	Article (Research - C1)
ISSN:	1879-1190
Copyright Information:	© 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.
Date Deposited:	15 May 2025 00:14
FoR Codes:	42 HEALTH SCIENCES > 4206 Public health > 420602 Health equity @ 70% 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320226 Surgery @ 30%
SEO Codes:	20 HEALTH > 2002 Evaluation of health and support services > 200204 Health inequalities @ 100%
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