Mediators of racial disparities in postoperative outcomes among patients undergoing complex surgery

Abstract

BackgroundThis study sought to quantify the direct and indirect effects of race on postoperative outcomes after complex surgery. MethodsMedicare patients who underwent abdominal aortic aneurysm (AAA) repair, coronary artery bypass grafting (CABG), lung resection or colectomy were identified (2014–2018). Generalized structural equation modelling was utilized to quantify the direct and indirect effects of race on Textbook outcome (TO). ResultsAmong 930,033 patients, 46.8% of patients achieved a TO, with Black patients less likely to achieve a TO (referent: White; Black: OR 0.72, 95% CI 0.70–0.73). Notably, 32.3% of the disparities in TO were attributable to race itself, while 67.7% was explained by other factors. Specifically, residential segregation accounted for 39.4% of the lower TO rates among Black patients, while 21.0% was attributable to a high comorbidity burden. ConclusionsThese data highlight the need to target structural racism as a policy priority to promote a more equitable healthcare system.