Haft Mark, Schmerler Jessica, Prieskorn Blake P, Murdock Christopher J, Nelson Sarah, Srikumaran Uma, Best Matthew J
Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA.
West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA.
J Racial Ethn Health Disparities. 2025 May 23. doi: 10.1007/s40615-025-02489-4.
Patients with Medicare or Medicaid and minorities have decreased access and worse surgical outcomes compared to privately insured and White patients, respectively. These disparities are poorly studied in urgent and emergent surgeries where surgical delays can increase morbidity and mortality. We aimed to evaluate the association between payer status and race/ethnicity and time to urgent/emergent surgery.
A retrospective cohort study was performed using the National Inpatient Sample from 2012 to 2020. A total of 1,799,580 patients aged ≥ 18 years were identified who underwent five different emergent surgeries. The primary outcome was time from admission to surgery. Multivariable linear regressions were performed controlling for age, sex, race, payer status, socioeconomic status, hospital setting, and Elixhauser Comorbidity Index score. Non-Hispanic White and privately insured patients were used as references.
Medicare and Medicaid patients had significantly increased time to surgery for CABG, PTCA, colon resection, and appendectomy. Non-Hispanic Black patients had significantly increased time to surgery for all procedures. Hispanic patients had significantly increased time to surgery for hip/femur fracture, CABG, PTCA, and colon resection (all p < 0.001).
Our comorbidity-controlled results demonstrate a significant increase in time to urgent/emergent surgery in patients with Medicare and Medicaid, and non-Hispanic Black and Hispanic patients compared to privately insured and non-Hispanic White patients, respectively. Given the increased morbidity and mortality associated with increased time to surgery in these procedures, our results stress the importance of renewed policy change efforts within the USA to address systemic surgical care disparities.
与拥有私人保险的患者和白人患者相比，参加医疗保险或医疗补助的患者以及少数族裔患者获得手术治疗的机会减少，手术结果也更差。在紧急和急诊手术中，这些差异的研究较少，而手术延迟会增加发病率和死亡率。我们旨在评估支付方状态、种族/族裔与紧急/急诊手术时间之间的关联。
利用2012年至2020年的全国住院患者样本进行了一项回顾性队列研究。共确定了1799580名年龄≥18岁且接受了五种不同急诊手术的患者。主要结局是从入院到手术的时间。进行了多变量线性回归分析，对年龄、性别、种族、支付方状态、社会经济地位、医院环境和埃利克斯豪泽合并症指数评分进行了控制。以非西班牙裔白人及拥有私人保险的患者作为对照。
医疗保险和医疗补助患者在冠状动脉搭桥术、经皮冠状动脉腔内血管成形术、结肠切除术和阑尾切除术中的手术时间显著增加。非西班牙裔黑人患者在所有手术中的手术时间均显著增加。西班牙裔患者在髋部/股骨骨折、冠状动脉搭桥术、经皮冠状动脉腔内血管成形术和结肠切除术中的手术时间显著增加（所有p<0.001）。
我们在控制合并症后的结果表明，与拥有私人保险的患者和非西班牙裔白人患者相比，参加医疗保险和医疗补助的患者以及非西班牙裔黑人和西班牙裔患者的紧急/急诊手术时间显著增加。鉴于这些手术中手术时间延长会增加发病率和死亡率，我们的结果强调了美国重新开展政策变革努力以解决系统性手术护理差异的重要性。
