Surgical Disparities in the United States from 2012 to 2020: Race and Payer Status are Associated with Increased Time to Urgent and Emergent Surgery.

INTRODUCTION

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.