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Surgical Endoscopy

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01-03-2020 | Laparoscopy | 2019 SAGES Oral

Access to common laparoscopic general surgical procedures: do racial disparities exist?

Authors: Kasey Leigh Wood, Syed F. Haider, Anthony Bui, I. Michael Leitman

Published in: Surgical Endoscopy | Issue 3/2020

Abstract

Background

Laparoscopy has become the standard of care for the majority of cases for inguinal hernia repair, cholecystectomy, appendectomy, and colectomy due to the shortened patient recovery time compared to open surgery. This study sought to determine if there exists racial disparity in access to a laparoscopic approach to these common surgeries.

Methods

This was an IRB-approved retrospective study utilizing data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Individuals who underwent inguinal hernia repair, cholecystectomy, appendectomy, and colectomy in 2016 were identified. Information on self-reported race and ethnicity and other demographic and pre-operative clinical covariates were recorded. Propensity matching was conducted to evaluate the association between race and a laparoscopic approach to surgery.

Results

There were 44,522, 60,444, 50,523, and 58,012 cases of inguinal hernia repair, cholecystectomy, appendectomy, and colectomy identified, respectively. Of these patients, 8.38, 8.76, 6.69, and 9.02% self-identified as black, respectively. Confounding effects of variables other than race were balanced by propensity matching. After propensity matching, there were 7460, 10,574, 10,470, and 6758 cases of hernia repair, cholecystectomy, colectomy, and appendectomy, respectively. On univariate (Chi square) analysis with laparoscopic surgery as the primary outcome, black race was significantly associated with lower likelihood of undergoing a minimally-invasive surgical approach in all four surgical procedures under investigation (33.86% of white patients and 21.69% of black patients, p < 0.0001 for hernia repair; 97.98% of white patients and 94.29%, p < 0.0001 of black patients for cholecystectomy; 70.93% of white patients and 48.60% of black patients, p < 0.0001 for colectomy; and 98.85% of white patients and 92.81% of black patients, p < 0.0001 for appendectomy).

Conclusions

There appears to be a significant racial disparity in the application of a laparoscopic approach to routine intra-abdominal surgery. This warrants further investigation into the barriers preventing access to laparoscopic general surgical procedures that certain populations face.

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Title: Access to common laparoscopic general surgical procedures: do racial disparities exist?
Authors: Kasey Leigh Wood
Syed F. Haider
Anthony Bui
I. Michael Leitman
Publication date: 01-03-2020
Publisher: Springer US
Keywords: Laparoscopy
Colectomy
Colectomy
Cholecystectomy
Inguinal Hernia
Appendectomy
Published in: Surgical Endoscopy / Issue 3/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-06912-w

At a glance: The STEP trials

Springer Medicine

Access to common laparoscopic general surgical procedures: do racial disparities exist?

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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