Racial disparities in length-of-stay persist even with no postoperative complications

Abstract

Background: To determine the contribution of race to postoperative length-of-stay in elective colorectal surgery without complications.

Methods: The 2012-2013 National Surgical Quality Improvement Program Colectomy-Targeted Database was queried for patients undergoing elective colorectal surgery without complications. After stratifying by race, univariate/bivariate comparisons were made. On adjusted comparison, predictors of postoperative length-of-stay were identified along with incident rate ratios and Least Squares Means for predicted length-of-stays.

Results: Of 28,480 elective colorectal surgeries, 19,898 patients had no postoperative complications. Patients stratified to white (84%), black (8%), Hispanic (3%), and Asian (3%). Overall mean postoperative length-of-stay was 4.8 d, with black patients having the longest at 5.3 d (P < 0.05). After covariate adjustment, black race increased postoperative length-of-stay by 9%, 7%, and 6% compared to white, Hispanic, and Asian patients, respectively (P < 0.05). No statistical difference existed in postoperative length-of-stay for Hispanic and Asian patients versus white patients. Adjusted postoperative length-of-stay was 5.1 d for black patients compared to 4.7, 4.8, and 4.8 d for white, Hispanic, and Asian patients, respectively (P < 0.05).

Conclusions: Black patients have significantly longer postoperative length-of-stay after elective colorectal surgery even if no postoperative complications occur. Further studies are needed to understand the mechanism(s) for these disparities.

Keywords: Colorectal surgery; Healthcare disparity; Racial disparity.