Disparities/Minority Health

Minority patients are less likely to have surgery performed by high-volume surgeons and hospitals

When it comes to major surgical procedures, there is a widespread perception that experience is the key. Many believe that outcomes are better when these surgeries are performed by high-volume surgeons in high-volume hospitals. However, not all patients are receiving these surgical advantages. A new study found that minorities in New York City were significantly less likely to have their surgeries performed by high-volume surgeons at high-volume centers.

Researchers reviewed hospital discharge data from New York City hospitals between 2001 and 2004. The focus was on 10 surgical procedures where there is a direct relationship between hospital/physician volume and reduced short-term patient mortality. Examples of such procedures include heart bypass surgery, total hip replacement, and various organ-specific cancer surgeries.

A total of 133,821 patients underwent one of the 10 procedures. Although the use of high-volume surgeons and hospitals varied widely across procedures, the researchers found that minority patients had a lower use of these providers and institutions. For 9 of the 10 procedures, black patients were significantly less likely to have their surgery performed by a high-volume surgeon in a high-volume hospital. This was the case even after the researchers adjusted for such factors as insurance type and geographic proximity to high-volume providers. Instead, black patients were more likely to have a less-experienced surgeon perform the surgery at a low-volume hospital. Asian and Hispanic patients were also significantly less likely to use high-volume providers. Compared with white patients, high-volume treatment was lower by 11.8 percent for blacks, 8 percent for Asians, and 7 percent for Hispanics across all procedures. According to the researchers, these disparities may be explained by entrenched referral patterns that vary by patient race/ethnicity, and poor patient access to information on report card ratings of hospitals and surgeons. The study was supported in part by the Agency for Healthcare Research and Quality (HS14074).

See "Racial and ethnic differences in the use of high-volume hospitals and surgeons," by Andrew J. Epstein, Ph.D., Bradford H. Gray, Ph.D., and Mark Schlesinger, Ph.D. in the February 2010 Archives of Surgery 145(2), pp. 179-186.

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