Racial Disparity in the Surgical Management of Diverticular Disease

Introduction Although minimally invasive surgery (MIS) has clearly been associated with improved colorectal surgery outcomes, not all populations benefit from this approach. Using a national database, we analyzed both, the trend in the utilization of MIS for diverticulitis and differences in utiliza...

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Veröffentlicht in:The American surgeon 2022-05, Vol.88 (5), p.929-935
Hauptverfasser: Akram, Warqaa M., Vohra, Nasreen, Irish, William, Zervos, Emmanuel E., Wong, Jan
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container_end_page 935
container_issue 5
container_start_page 929
container_title The American surgeon
container_volume 88
creator Akram, Warqaa M.
Vohra, Nasreen
Irish, William
Zervos, Emmanuel E.
Wong, Jan
description Introduction Although minimally invasive surgery (MIS) has clearly been associated with improved colorectal surgery outcomes, not all populations benefit from this approach. Using a national database, we analyzed both, the trend in the utilization of MIS for diverticulitis and differences in utilization by race. Methods Colon-targeted participant user files (PUFs) from 2012 to 18 were linked to respective PUFs in National Surgical Quality Improvement Project. Patients undergoing colectomy for acute diverticulitis or chronic diverticular disease were included. Surgical approach was stratified by race and year. To adjust for confounding and estimate the association of covariates with approach, data were fit using multivariable binary logistic regression main effects model. Using a joint effects model, we evaluated whether the odds of a particular approach over time was differentially affected by race. Results Of the 46 713 patients meeting inclusion criteria, 83% were white, with 7% black and 10% other. Over the study period, there was a decrease in the rate of open colectomy of about 5% P < .001, and increase in the rate of utilization of laparoscopic and robotic approaches (RC) P < .0001. After adjusting for confounders, black race was associated with open surgery P < .0001. Conclusion There is disparity in the utilization of MIS for diverticulitis. Further research into the reasons for this disparity is critical to ensure known benefits of MIC are realized across all races.
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Using a national database, we analyzed both, the trend in the utilization of MIS for diverticulitis and differences in utilization by race. Methods Colon-targeted participant user files (PUFs) from 2012 to 18 were linked to respective PUFs in National Surgical Quality Improvement Project. Patients undergoing colectomy for acute diverticulitis or chronic diverticular disease were included. Surgical approach was stratified by race and year. To adjust for confounding and estimate the association of covariates with approach, data were fit using multivariable binary logistic regression main effects model. Using a joint effects model, we evaluated whether the odds of a particular approach over time was differentially affected by race. Results Of the 46 713 patients meeting inclusion criteria, 83% were white, with 7% black and 10% other. Over the study period, there was a decrease in the rate of open colectomy of about 5% P &lt; .001, and increase in the rate of utilization of laparoscopic and robotic approaches (RC) P &lt; .0001. After adjusting for confounders, black race was associated with open surgery P &lt; .0001. Conclusion There is disparity in the utilization of MIS for diverticulitis. 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Using a national database, we analyzed both, the trend in the utilization of MIS for diverticulitis and differences in utilization by race. Methods Colon-targeted participant user files (PUFs) from 2012 to 18 were linked to respective PUFs in National Surgical Quality Improvement Project. Patients undergoing colectomy for acute diverticulitis or chronic diverticular disease were included. Surgical approach was stratified by race and year. To adjust for confounding and estimate the association of covariates with approach, data were fit using multivariable binary logistic regression main effects model. Using a joint effects model, we evaluated whether the odds of a particular approach over time was differentially affected by race. Results Of the 46 713 patients meeting inclusion criteria, 83% were white, with 7% black and 10% other. Over the study period, there was a decrease in the rate of open colectomy of about 5% P &lt; .001, and increase in the rate of utilization of laparoscopic and robotic approaches (RC) P &lt; .0001. After adjusting for confounders, black race was associated with open surgery P &lt; .0001. Conclusion There is disparity in the utilization of MIS for diverticulitis. 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Using a national database, we analyzed both, the trend in the utilization of MIS for diverticulitis and differences in utilization by race. Methods Colon-targeted participant user files (PUFs) from 2012 to 18 were linked to respective PUFs in National Surgical Quality Improvement Project. Patients undergoing colectomy for acute diverticulitis or chronic diverticular disease were included. Surgical approach was stratified by race and year. To adjust for confounding and estimate the association of covariates with approach, data were fit using multivariable binary logistic regression main effects model. Using a joint effects model, we evaluated whether the odds of a particular approach over time was differentially affected by race. Results Of the 46 713 patients meeting inclusion criteria, 83% were white, with 7% black and 10% other. Over the study period, there was a decrease in the rate of open colectomy of about 5% P &lt; .001, and increase in the rate of utilization of laparoscopic and robotic approaches (RC) P &lt; .0001. After adjusting for confounders, black race was associated with open surgery P &lt; .0001. Conclusion There is disparity in the utilization of MIS for diverticulitis. Further research into the reasons for this disparity is critical to ensure known benefits of MIC are realized across all races.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>34964694</pmid><doi>10.1177/00031348211058623</doi><tpages>7</tpages></addata></record>
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subjects Colectomy
Colon
Comorbidity
Diabetes
Disease
Diverticular Diseases
Diverticulitis
Diverticulitis - surgery
Dyspnea
Ethnicity
Gender
Hospitals
Humans
Hypertension
Laparoscopy
Minimally invasive surgery
Minimally Invasive Surgical Procedures
Native North Americans
Pacific Islander people
Patients
Postoperative Complications
Quality control
Quality improvement
Race
Race factors
Regression analysis
Regression models
Retrospective Studies
Robotic surgery
Sepsis
Statistical analysis
Surgery
Trends
Utilization
Variables
title Racial Disparity in the Surgical Management of Diverticular Disease
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