Authors: Taneze Y et al.
Anesthesia & Analgesia, 2026 (Letter to the Editor)
This Letter to the Editor emphasizes the importance of incorporating hospital identifiers when evaluating racial and ethnic disparities in failure-to-rescue (FTR) outcomes following surgery.
The authors respond to prior work analyzing racial disparities in postoperative sepsis-related mortality using American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data. While prior findings suggested limited evidence of racial disparities in FTR, the letter argues that excluding hospital-level identifiers may mask important structural contributors.
Key Arguments Presented
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Hospital-level context matters
Hospital identifiers allow researchers to evaluate whether disparities arise within hospitals (suggesting differential treatment) or between hospitals (suggesting structural inequities in where patients receive care). -
Safety-net hospitals
Hospitals serving disproportionately Black, Hispanic, and socioeconomically disadvantaged populations—often referred to as safety-net hospitals—may operate with limited resources. These institutions frequently care for higher proportions of uninsured or publicly insured patients and may lack infrastructure for advanced quality-improvement initiatives. -
Between-hospital disparities
Including hospital-level data could clarify whether variation in FTR rates reflects systemic institutional constraints rather than patient-level differences alone. This distinction has implications for policy design and equity-based interventions. -
Persistent cardiovascular care disparities
The authors cite growing evidence that disparities in outcomes are often linked to hospital context and resource distribution. Understanding provider- and system-level contributors may better guide targeted quality improvement.
The central thesis is that equity-sensitive outcomes research must integrate institutional identifiers to avoid overlooking structural healthcare factors. Without this, analyses may underestimate or misattribute disparities in surgical rescue performance.
Key Points
• Failure-to-rescue analyses without hospital identifiers may obscure structural healthcare inequities.
• Safety-net hospitals often face resource constraints that can influence postoperative outcomes.
• Distinguishing within-hospital versus between-hospital variation is critical in disparity research.
• Policy solutions require understanding whether disparities reflect care delivery differences or institutional resource variation.
What You Should Know
This letter reinforces a recurring theme in perioperative outcomes research: patient-level adjustment alone is not sufficient. For departments and organizations engaged in quality improvement, evaluating institutional context—including staffing models, ICU resources, rapid response systems, and escalation protocols—is essential when interpreting disparity data.
For leaders overseeing multi-site anesthesia operations, this perspective highlights the importance of benchmarking by facility and recognizing that structural inequities may influence outcomes even when individual clinicians provide similar care.
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