Examining Causes of Racial Disparities in General Surgical Mortality: Hospital Quality Versus Patient Risk

BACKGROUND:Racial disparities in general surgical outcomes are known to exist but not well understood. OBJECTIVES:To determine if black-white disparities in general surgery mortality for Medicare patients are attributable to poorer health status among blacks on admission or differences in the quality of care provided by the admitting hospitals. RESEARCH DESIGN:Matched cohort study using Tapered Multivariate Matching. SUBJECTS:All black elderly Medicare general surgical patients (N=18,861) and white-matched controls within the same 6 states or within the same 838 hospitals. MEASURES:Thirty-day mortality (primary); others include in-hospital mortality, failure-to-rescue, complications, length of stay, and readmissions. RESULTS:Matching on age, sex, year, state, and the exact same procedure, blacks had higher 30-day mortality (4.0% vs. 3.5%, P