Kasey L Wood, BS, Anthony H Bui, BS, Syed F Haider, BS, I. Michael Leitman, MD, FACS. The Icahn School of Medicine at Mount Sinai
INTRODUCTION: Minimally invasive surgery has become the preferred approach for the majority of cases for inguinal hernia repair, cholecystectomy, appendectomy, and colectomy due to the shortened patient recovery time compared to open surgery. The purpose of this study was to determine if racial disparities exist in access to a laparoscopic approach for these procedures.
METHODS AND PROCEDURES: This was an IRB-approved retrospective study utilizing data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). Individuals who underwent inguinal hernia repair, cholecystectomy, appendectomy, or colectomy in 2016 were identified. Information on self-reported race and ethnicity, as well as other demographic and pre-operative clinical covariates, were recorded. Propensity matching was conducted to evaluate the association between race and utilization of laparoscopic surgery.
RESULTS: There were 44,522, 60,444, 50,523, and 58,012 cases of inguinal hernia repair, cholecystectomy, appendectomy, and colectomy identified, respectively. Of these patients, 8.38%, 8.76%, 6.69%, and 9.02% self-identified as black, respectively. The confounding effects of variables other than race were balanced by propensity matching. After matching, there were 7,460, 10,574, 10,470, and 6,758 cases of hernia repair, cholecystectomy, colectomy, and appendectomy, respectively. On univariate (chi-square) analysis with laparoscopic surgery as the primary outcome, black race was significantly associated with lower likelihood of undergoing a minimally invasive surgical approach in all four surgical procedures under investigation, (33.86% of white people and 21.69% of black people, p<0.0001 for hernia repair; 97.98% of white people and 94.29%, p<0.0001 of black people for cholecystectomy; 70.93% of white people and 48.60% of black people, p<0.0001 for colectomy; and 98.85% of white people and 92.81% of black people, p<0.0001 for appendectomy).
CONCLUSION(S): Significant racial disparity exists nationwide in the application of a minimally invasive approach to patients undergoing inguinal hernia repair, cholecystectomy, appendectomy, and colectomy. These findings warrant further investigation into the barriers preventing access to laparoscopic general surgical procedures that these populations might undergo.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94460
Program Number: S166
Presentation Session: Disparities
Presentation Type: Podium