HCA Florida Aventura Hospital
morbidity, mortality, cholecystectomy, social determinants of health
Medicine and Health Sciences | Surgery | Surgical Procedures, Operative
Background: Social determinants of health, such as race and ethnicity, can have a significant impact on people's health and well-being. People of color are more likely to experience poverty, lack of access to healthcare, and discrimination, which can lead to worse health outcomes. Laparoscopic cholecystectomy is a surgical procedure to remove the gallbladder. It is the most common gastrointestinal surgery performed in the United States. In this study, we sought to determine if there is an association between race/ethnicity and morbidity/mortality in adult patients undergoing laparoscopic cholecystectomy.
Methods: We conducted a non-concurrent cohort study of patients over 18 years old who underwent laparoscopic cholecystectomy at an American College of Surgeons' National Surgical Quality Improvement Program hospital in 2016. The main exposure variables were race (Black/African American, white, or other) and ethnicity (Hispanic vs. non-Hispanic). The main outcome was the probability of morbidity and mortality. Morbidity refers to any complication that occurs as a result of the surgery, such as infection, bleeding, or pneumonia. Mortality refers to death. Unadjusted and adjusted logistic regression analysis were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
Results: Hispanics and Black/African Americans had decreased odds of mortality compared to white patients (OR 0.48; 95% CI 0.44-0.52 and OR 0.85; 95% CI 0.78-0.92, respectively). However, Black/African Americans had increased odds of morbidity compared to white patients (OR 1.43; 95% CI 1.32-1.54).
Conclusion: Social determinants of health, such as race and ethnicity, have a significant impact on patients' access to and quality of care. These factors can evolve over time, and their impact on patient outcomes is complex and multifaceted. We recommend that the American College of Surgeons (ACS) consider adding race and ethnicity to their surgery risk calculator, as our study suggests that these factors play a role in the probability of morbidity and mortality. We also encourage future studies to assess other social determinants of health, such as socioeconomic status, for inclusion in such calculators. In addition to race and ethnicity, our incidental findings suggest that length of surgery and transfer sites may also play a role in patients' probability of morbidity and mortality. Further research is needed to explore these relationships in more detail.
Meray, Victorien and Seetharamaiah, Rupa, "Race/Ethnicity and Morbidity/Mortality in Laparoscopic Cholecystectomy: 2016 USA Study" (2023). East Florida Research Day 2023. 54.