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...
Gespeichert in:
Veröffentlicht in: | The American surgeon 2022-05, Vol.88 (5), p.929-935 |
---|---|
Hauptverfasser: | , , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
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. |
doi_str_mv | 10.1177/00031348211058623 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2615299997</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_00031348211058623</sage_id><sourcerecordid>2649514548</sourcerecordid><originalsourceid>FETCH-LOGICAL-c368t-865026686b558c7cbce256eeb8c687dd05a9f5cf95360ec3518e5975236955d83</originalsourceid><addsrcrecordid>eNp1kE1LxDAQhoMo7rr6A7xIwYuXatJ00uQo6yesCH6cS5pO1yzddk1aYf-9KbsqKM5lGOZ53xleQo4ZPWcsyy4opZzxVCaMUZAi4TtkzAAgVjLhu2Q87OMBGJED7xdhTAWwfTLiqRKpUOmYTJ-0sbqOrqxfaWe7dWSbqHvD6Ll3c2vC5kE3eo5LbLqorQL3ga6zpq-1G0SoPR6SvUrXHo-2fUJeb65fpnfx7PH2fno5iw0XsoulAJoIIUUBIE1mCoMJCMRCGiGzsqSgVQWmUsAFRcOBSQSVQcKFAigln5Czje_Kte89-i5fWm-wrnWDbe_zRDBIVKgsoKe_0EXbuyZ8F6hUAUshHQzZhjKu9d5hla-cXWq3zhnNh4TzPwkHzcnWuS-WWH4rviINwPkG8CG2n7P_O34Co3GAdQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2649514548</pqid></control><display><type>article</type><title>Racial Disparity in the Surgical Management of Diverticular Disease</title><source>MEDLINE</source><source>SAGE Complete A-Z List</source><creator>Akram, Warqaa M. ; Vohra, Nasreen ; Irish, William ; Zervos, Emmanuel E. ; Wong, Jan</creator><creatorcontrib>Akram, Warqaa M. ; Vohra, Nasreen ; Irish, William ; Zervos, Emmanuel E. ; Wong, Jan</creatorcontrib><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.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/00031348211058623</identifier><identifier>PMID: 34964694</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>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</subject><ispartof>The American surgeon, 2022-05, Vol.88 (5), p.929-935</ispartof><rights>The Author(s) 2021</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-865026686b558c7cbce256eeb8c687dd05a9f5cf95360ec3518e5975236955d83</citedby><cites>FETCH-LOGICAL-c368t-865026686b558c7cbce256eeb8c687dd05a9f5cf95360ec3518e5975236955d83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/00031348211058623$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/00031348211058623$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34964694$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Akram, Warqaa M.</creatorcontrib><creatorcontrib>Vohra, Nasreen</creatorcontrib><creatorcontrib>Irish, William</creatorcontrib><creatorcontrib>Zervos, Emmanuel E.</creatorcontrib><creatorcontrib>Wong, Jan</creatorcontrib><title>Racial Disparity in the Surgical Management of Diverticular Disease</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><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.</description><subject>Colectomy</subject><subject>Colon</subject><subject>Comorbidity</subject><subject>Diabetes</subject><subject>Disease</subject><subject>Diverticular Diseases</subject><subject>Diverticulitis</subject><subject>Diverticulitis - surgery</subject><subject>Dyspnea</subject><subject>Ethnicity</subject><subject>Gender</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Laparoscopy</subject><subject>Minimally invasive surgery</subject><subject>Minimally Invasive Surgical Procedures</subject><subject>Native North Americans</subject><subject>Pacific Islander people</subject><subject>Patients</subject><subject>Postoperative Complications</subject><subject>Quality control</subject><subject>Quality improvement</subject><subject>Race</subject><subject>Race factors</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Retrospective Studies</subject><subject>Robotic surgery</subject><subject>Sepsis</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Trends</subject><subject>Utilization</subject><subject>Variables</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1LxDAQhoMo7rr6A7xIwYuXatJ00uQo6yesCH6cS5pO1yzddk1aYf-9KbsqKM5lGOZ53xleQo4ZPWcsyy4opZzxVCaMUZAi4TtkzAAgVjLhu2Q87OMBGJED7xdhTAWwfTLiqRKpUOmYTJ-0sbqOrqxfaWe7dWSbqHvD6Ll3c2vC5kE3eo5LbLqorQL3ga6zpq-1G0SoPR6SvUrXHo-2fUJeb65fpnfx7PH2fno5iw0XsoulAJoIIUUBIE1mCoMJCMRCGiGzsqSgVQWmUsAFRcOBSQSVQcKFAigln5Czje_Kte89-i5fWm-wrnWDbe_zRDBIVKgsoKe_0EXbuyZ8F6hUAUshHQzZhjKu9d5hla-cXWq3zhnNh4TzPwkHzcnWuS-WWH4rviINwPkG8CG2n7P_O34Co3GAdQ</recordid><startdate>202205</startdate><enddate>202205</enddate><creator>Akram, Warqaa M.</creator><creator>Vohra, Nasreen</creator><creator>Irish, William</creator><creator>Zervos, Emmanuel E.</creator><creator>Wong, Jan</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7T7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>202205</creationdate><title>Racial Disparity in the Surgical Management of Diverticular Disease</title><author>Akram, Warqaa M. ; Vohra, Nasreen ; Irish, William ; Zervos, Emmanuel E. ; Wong, Jan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-865026686b558c7cbce256eeb8c687dd05a9f5cf95360ec3518e5975236955d83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Colectomy</topic><topic>Colon</topic><topic>Comorbidity</topic><topic>Diabetes</topic><topic>Disease</topic><topic>Diverticular Diseases</topic><topic>Diverticulitis</topic><topic>Diverticulitis - surgery</topic><topic>Dyspnea</topic><topic>Ethnicity</topic><topic>Gender</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Laparoscopy</topic><topic>Minimally invasive surgery</topic><topic>Minimally Invasive Surgical Procedures</topic><topic>Native North Americans</topic><topic>Pacific Islander people</topic><topic>Patients</topic><topic>Postoperative Complications</topic><topic>Quality control</topic><topic>Quality improvement</topic><topic>Race</topic><topic>Race factors</topic><topic>Regression analysis</topic><topic>Regression models</topic><topic>Retrospective Studies</topic><topic>Robotic surgery</topic><topic>Sepsis</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Trends</topic><topic>Utilization</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Akram, Warqaa M.</creatorcontrib><creatorcontrib>Vohra, Nasreen</creatorcontrib><creatorcontrib>Irish, William</creatorcontrib><creatorcontrib>Zervos, Emmanuel E.</creatorcontrib><creatorcontrib>Wong, Jan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Akram, Warqaa M.</au><au>Vohra, Nasreen</au><au>Irish, William</au><au>Zervos, Emmanuel E.</au><au>Wong, Jan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Racial Disparity in the Surgical Management of Diverticular Disease</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2022-05</date><risdate>2022</risdate><volume>88</volume><issue>5</issue><spage>929</spage><epage>935</epage><pages>929-935</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>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.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>34964694</pmid><doi>10.1177/00031348211058623</doi><tpages>7</tpages></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0003-1348 |
ispartof | The American surgeon, 2022-05, Vol.88 (5), p.929-935 |
issn | 0003-1348 1555-9823 |
language | eng |
recordid | cdi_proquest_miscellaneous_2615299997 |
source | MEDLINE; SAGE Complete A-Z List |
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 |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-06T02%3A30%3A40IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Racial%20Disparity%20in%20the%20Surgical%20Management%20of%20Diverticular%20Disease&rft.jtitle=The%20American%20surgeon&rft.au=Akram,%20Warqaa%20M.&rft.date=2022-05&rft.volume=88&rft.issue=5&rft.spage=929&rft.epage=935&rft.pages=929-935&rft.issn=0003-1348&rft.eissn=1555-9823&rft_id=info:doi/10.1177/00031348211058623&rft_dat=%3Cproquest_cross%3E2649514548%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2649514548&rft_id=info:pmid/34964694&rft_sage_id=10.1177_00031348211058623&rfr_iscdi=true |