Racial disparities in operative procedure time: the influence of obesity.

Auteur(s) :
Silber JH., Rosenbaum PR., Ross RN.
Date :
Juil, 2013
Source(s) :
ANESTHESIOLOGY. #119:1 p43-51
Adresse :
* Professor, Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; The Departments of Pediatrics and Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, Pennsylvania; and The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania. † Professor, Department of Statistics, The Wharton School, The University of Pennsylvania, and The Leonard Davis Institute of Health Economics, The University of Pennsylvania. ‡ Senior Statistician, †† Statistical Programmer, ‡‡ Research Assistant, Center for Outcomes Research, The Children's Hospital of Philadelphia. § Associate Director, Center for Outcomes Research, The Children's Hospital of Philadelphia, and The Leonard Davis Institute of Health Economics, The University of Pennsylvania. ‖ Assistant Professor, ** Instructor, Department of Surgery, The University of Pennsylvania School of Medicine. # Assistant Professor, ‖‖ Professor, Department of Anesthesiology and Critical Care, The University of Pennsylvania School of Medicine, and The Leonard Davis Institute of Health Economics, The University of Pennsylvania. §§ Professor, Oklahoma University Health Sciences Center, College of Public Health and College of Medicine, Oklahoma City, Oklahoma, and Oklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma.

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BACKGROUND: Using Pennsylvania Medicare claims from 1995 to 1996, the authors previously reported that anesthesia procedure length appears longer in blacks than whites. In a new study using a different and larger data set, the authors now examine whether body mass index (BMI), not available in Medicare claims, explains this difference. The authors also examine the relative contributions of surgical and anesthesia times.

METHODS: The Obesity and Surgical Outcomes Study of 47 hospitals throughout Illinois, New York, and Texas abstracted chart information including BMI on elder Medicare patients (779 blacks and 14,596 whites) undergoing hip and knee replacement and repair, colectomy, and thoracotomy between 2002 and 2006. The authors matched all black Medicare patients to comparable whites and compared procedure lengths.

RESULTS: Mean BMI in the black and white populations was 30.24 and 28.96 kg/m, respectively (P < 0.0001). After matching on age, sex, procedure, comorbidities, hospital, and BMI, mean white BMI in the comparison group was 30.1 kg/m (P = 0.94). The typical matched pair difference (black-white) in anesthesia (induction to recovery room) procedure time was 7.0 min (P = 0.0019), of which 6 min reflected the surgical (cut-to-close) time difference (P = 0.0032). Within matched pairs, where the difference in procedure times was greater than 30 min between patients, blacks more commonly had longer procedure times (Odds = 1.39; P = 0.0008).

CONCLUSIONS: Controlling for patient characteristics, BMI, and hospital, elder black Medicare patients experienced slightly but significantly longer procedure length than their closely matched white controls. Procedure length difference was almost completely due to surgery, not anesthesia.

Source : Pubmed
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