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Utilization of minimally invasive colectomy at safety-net hospitals in the United States. | LitMetric

AI Article Synopsis

  • Safety-net hospitals have worse surgical outcomes and lower access to minimally invasive surgeries for elective colectomy compared to non-safety-net hospitals, according to data from 2016-2020.
  • Of the nearly 533,000 patients studied, those treated at safety-net hospitals were more likely to be younger and from racial/ethnic minority groups, particularly Black and Hispanic patients.
  • Patients at safety-net hospitals experienced higher rates of in-hospital mortality, greater complications, longer hospital stays, and increased healthcare costs, indicating significant disparities in surgical care.

Article Abstract

Background: Prior literature has reported inferior surgical outcomes and reduced access to minimally invasive procedures at safety-net hospitals. However, this relationship has not yet been elucidated for elective colectomy. We sought to characterize the association between safety-net hospitals and likelihood of minimally invasive resection, perioperative outcomes, and costs.

Methods: All adult (≥18 years) hospitalization records entailing elective colectomy were identified in the 2016-2020 National Inpatient Sample. Centers in the top quartile of safety-net burden were considered safety-net hospitals (others: non-safety-net hospitals). Multivariable regression models were developed to assess the impact of safety-net hospitals status on key outcomes.

Results: Of ∼532,640 patients, 95,570 (17.9%) were treated at safety-net hospitals. The safety-net hospitals cohort was younger and more often of Black race or Hispanic ethnicity. After adjustment, care at safety-net hospitals remained independently associated with reduced odds of minimally invasive surgery (adjusted odds ratio 0.92; 95% confidence interval 0.87-0.97). The interaction between safety-net hospital status and race was significant, such that Black race remained linked with lower odds of minimally invasive surgery at safety-net hospitals (reference: White race). Additionally, safety-net hospitals was associated with greater likelihood of in-hospital mortality (adjusted odds ratio 1.34, confidence interval 1.04-1.74) and any perioperative complication (adjusted odds ratio 1.15, confidence interval 1.08-1.22), as well as increased length of stay (β+0.26 days, confidence interval 0.17-0.35) and costs (β+$2,510, confidence interval 2,020-3,000).

Conclusion: Care at safety-net hospitals was linked with lower odds of minimally invasive colectomy, as well as greater complications and costs. Black patients treated at safety-net hospitals demonstrated reduced likelihood of minimally invasive surgery, relative to White patients. Further investigation is needed to elucidate the root causes of these disparities in care.

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Source
http://dx.doi.org/10.1016/j.surg.2024.03.036DOI Listing

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