Racial disparities in surgical mortality are shrinking

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As mortality rates have improved overall, there have also been improvements in previously-seen racial disparities between the surgical mortality of black and white patients, with reductions occurring primarily within hospitals, rather than between hospitals.

The study was led by Massachusetts General Hospital surgery resident and Harvard University health policy fellow Winta Tsegay Mehtsun, MD and published in the June 2017 issue of Health Affairs, which focused on issues surrounding inequality in healthcare.

Racial disparities in care and outcomes have been commonly reported during this century, including among breast and lung cancer patients. Those reports have led to national efforts to improve surgical quality, but only in general, with few initiatives focused particularly on the racial disparity in post-surgical mortality between blacks and whites.

However, the overall decline appears to have significantly narrowed that racial gap. Using Medicare inpatient claims data from 2005 to 2014, 30-day mortality improved by 0.10 percent per year for black patients and 0.07 percent per year for white patients.

The study selected outcomes for five high-risk procedures (coronary artery bypass graft, abdominal aortic aneurysm, endovascular repair, pulmonary lobectomy, colectomy and hip replacement) and three low-risk (appendectomy, cholecystectomy and knee replacement). For the high-risk procedures, black patients had a composite 30-day mortality rate in 2005 of 5.38 percent compared to 4.90 percent for white patients. Those rates had decreased by 0.10 percent per year for black patients and 0.08 percent for white patients over the study period.

For low-risk procedures, the narrowing of the racial gap was even more pronounced, shrinking from 0.67 percentage point difference between black and white patients to 0.04 percentage points.

The improvements, however, came from better rates within institutions, not from patients switching to higher-quality hospitals. They also didn’t come from the hospitals treating the patients most affected by the disparity.

“The largest improvements in mortality rates for black patients occurred among small, public hospitals that were not minority-serving institutions,” Mehtsun and her coauthors wrote. “Taken together, these findings are good news for policy makers interested in seeing reductions in disparities in mortality after major surgery, yet they also highlight the need to focus more on minority-serving hospitals.”