Shannon Evan Michael, Blegen Mariah B, Orav E John, Li Ruixin, Norris Keith C, Maggard-Gibbons Melinda, Dimick Justin B, de Virgilio Christian, Zingmond David, Alberti Philip, Tsugawa Yusuke
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
BMJ Open. 2025 Mar 3;15(3):e089900. doi: 10.1136/bmjopen-2024-089900.
To examine the association of patient-surgeon racial and ethnic concordance with postoperative outcomes among older adults treated by surgeons with California medical licences.
Retrospective cohort study.
US acute care and critical access hospitals in 2016-2019.
100% Medicare fee-for-service beneficiaries aged 65-99 years who underwent one of 14 common surgical procedures (abdominal aortic aneurysm repair, appendectomy, coronary artery bypass grafting, cholecystectomy, colectomy, cystectomy, hip replacement, hysterectomy, knee replacement, laminectomy, liver resection, lung resection, prostatectomy and thyroidectomy), who were operated on by surgeons with self-reported race and ethnicity (21.4% of surgeons) in the Medical Board of California database. We focused our primary analysis on black and Hispanic beneficiaries.
The outcomes assessed included (1) patient postoperative 30-day mortality, defined as death within 30 days after surgery including during the index hospitalisation, (2) 30-day readmission and (3) length of stay. We adjusted for patient, physician and hospital characteristics.
Among 1858 black and 4146 Hispanic patients treated by 746 unique surgeons (67 black, 98 Hispanic and 590 white surgeons; includes surgeons who selected multiple backgrounds), 977 (16.3%) patients were treated by a racially or ethnically concordant surgeon. Hispanic patients treated by concordant surgeons had lower 30-day readmission (adjusted readmission rate, 4.2% for concordant vs 6.6% for discordant dyad; adjusted risk difference, -2.4 percentage points (pp); 95% CI, -4.3 to -0.5 pp; p=0.014) and length of stay (adjusted length of stay, 4.1 d vs 4.6 days (d); adjusted difference, -0.5 d; 95% CI, -0.8 to -0.2 d; p=0.003) than those treated by discordant surgeons. We found no evidence that patient-surgeon racial and ethnic concordance was associated with surgical outcomes among black patients or mortality among Hispanic patients.
Patient-surgeon racial and ethnic concordance was associated with a lower postoperative readmission rate and length of stay for Hispanic patients. Increasing Hispanic surgeon representation may contribute to narrowing of racial and ethnic disparities in surgical outcomes.
研究在持有加利福尼亚州行医执照的外科医生治疗的老年患者中，患者与外科医生种族和民族一致性与术后结局之间的关联。
回顾性队列研究。
2016 - 2019年美国急症护理和基层医疗医院。
100%年龄在65 - 99岁的医疗保险按服务付费受益人，他们接受了14种常见外科手术之一（腹主动脉瘤修复术、阑尾切除术、冠状动脉搭桥术、胆囊切除术、结肠切除术、膀胱切除术、髋关节置换术、子宫切除术、膝关节置换术、椎板切除术、肝切除术、肺切除术、前列腺切除术和甲状腺切除术），这些患者由加利福尼亚州医务委员会数据库中自我报告种族和民族的外科医生进行手术（21.4%的外科医生）。我们将主要分析聚焦于黑人和西班牙裔受益人。
评估的结局包括：（1）患者术后30天死亡率，定义为手术后30天内死亡，包括在本次住院期间；（2）30天再入院率；（3）住院时间。我们对患者、医生和医院特征进行了调整。
在由746名不同外科医生（67名黑人、98名西班牙裔和590名白人外科医生；包括选择多种背景的外科医生）治疗的1858名黑人和4146名西班牙裔患者中，977名（16.3%）患者由种族或民族一致的外科医生治疗。与不一致的二元组相比，由一致的外科医生治疗的西班牙裔患者30天再入院率更低（调整后的再入院率，一致组为4.2%，不一致组为6.6%；调整后的风险差异为 - 2.4个百分点（pp）；95%置信区间为 - 4.3至 - 0.5 pp；p = 0.014），住院时间也更短（调整后的住院时间，一致组为4.1天，不一致组为4.6天；调整后的差异为 - 0.5天；95%置信区间为 - 0.8至 - 0.2天；p = 0.003）。我们没有发现证据表明患者与外科医生的种族和民族一致性与黑人患者的手术结局或西班牙裔患者的死亡率有关。
患者与外科医生的种族和民族一致性与西班牙裔患者较低的术后再入院率和住院时间有关。增加西班牙裔外科医生的比例可能有助于缩小手术结局方面的种族和民族差异。
