Surgery News- July 2008

J U LY 2 0 0 8 • SURGERY NEWS PRACTICE TRENDS 11 Rates of Minimally Invasive Surgery Differ by Race B Y J E F F E VA N S Else vier Global Medical Ne ws P H I L A D E L P H I A — Black patients at U.S. hospitals appear to be significantly less likely to undergo minimally invasive abdominal procedures and more likely to die or have certain complications than are white patients, according to an analysis of Nationwide Inpatient Sample data from 2004. Although the disparities in access to minimally invasive surgery (MIS) and surgical outcomes were small, study investigator Dr. Rocco Ricciardi argued that they were both clinically and statistically significant. To identify potential racial disparities in the use of MIS for benign surgical conditions and to determine whether any such disparities influence surgical outcomes, Dr. Ricciardi and his colleagues analyzed all primary cases of appendectomy, fundoplication, and gastric bypass with ICD-9 diagnostic and procedural codes that were recorded in the Nationwide Inpatient Sample (NIS) in 2004. The NIS includes hospital discharge abstracts for about 8 million hospital Rates of MIS were stays, representing significantly lower about 20% of U.S. hospital inpatients among blacks (27%) than among across 35 states. The investigators exwhites (34%) or cluded patients with Hispanics (39%). a surgical indication DR. RICCIARDI of malignancy, peptic ulcer disease, or GI bleeding. MIS techniques were used in 33% of 88,545 appendectomy, fundoplication, and gastric bypass procedures in the 2004 sample, Dr. Ricciardi reported at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons. Rates of MIS use were significantly lower among black patients (27%) than among white (34%) or Hispanic patients (39%). Black patients were 23% less likely to undergo surgery using MIS techniques than were white patients, after adjustment for age, sex, income, comorbidities (using the Charleston Comorbidity Index), hospital characteristics, surgical volume, and MIS conversion rate. The highest-volume hospitals fell into the lowest quintile for use of MIS, and black patients sought treatment most often at such hospitals, said Dr. Ricciardi, an ACS Fellow with the department of colon and rectal surgery at the Lahey Clinic, Burlington, Mass. Univariate analyses showed that patients who underwent MIS procedures had significantly lower mortality than did those who underwent open procedures (7 deaths/10,000 patients vs. 20/10,000). Black patients had a higher likelihood of dying in the hospital than did white patients (26 deaths/10,000 patients vs. 16/10,000). In multivariate analyses, patients who underwent a procedure using MIS were 47% less likely to die than were patients who underwent open procedures. Black patients also were twice as likely as white patients to die during hospitalization. In the postoperative period, black patients were significantly more likely than white patients to experience pneumonia (odds ratio 1.5), GI ulceration and bleeding (OR 1.51), respiratory complications (OR 1.24), cardiac complications (OR 2.96), other infections (OR 1.49), and “surgical misadventures” (OR 4.39). Dr. Yuri W. Novitsky of the University of Connecticut, Farmington, who dis- cussed the study at the meeting, questioned whether the results were attributable to patient-level factors and presenting clinical scenarios rather than access to MIS techniques, because a laparoscopic approach would not be appropriate for all patients. Dr. Novitsky also suggested that the “claims of racial disparities” that stem from a 0.1% overall increase in the surgical mortality of black patients vs. white patients “may be somewhat overstated.” However, Dr. Ricciardi thought that the 0.1% increase in mortality was clinically significant in addition to being statistically significant because it corresponded to a 63% increase in the odds of death in the univariate analysis and a doubling of the odds of death in the multivariate analysis. Previous studies have suggested that racial differences in surgical outcomes could be accounted for by financial and insurance constraints, genetic differences, segregated health care systems, and health care worker bias, Dr. Ricciardi said. ■ New InfoV.A.C. Therapy System ® Better by Design The Next Generation of V.A.C.® Therapy The InfoV.A.C.® Therapy System delivers the same positive outcomes you trust – but is now simpler and more efficient than ever.* Easier to Use. Designed with busy clinicians in mind. Simpler Training. Designed to be easier to learn, improving proficiency. Better Information. Designed to provide consistent wound progress tracking. Better by Design www.InfoVACTherapy.com • 1-800-275-4524 *As compared to V.A.C. ATS® Therapy Note: Specific indications, contraindications, warnings, precautions, and safety tips exist for this product and therapy. Please consult Product Instructions for Use prior to applications. ©2008 KCI Licensing, Inc. All rights reserved. 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Surgery News- July 2008 Contents The 20/20 Vision: Health Reform Trauma: Airway Anchor News From the College: Jacobson Winner General Surgery: Worth the Trouble

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