NEJM Journal Watch
Bruce Soloway, MD, reviewing
Mortality after elective procedures was 1.30% for Black men vs. 0.85% for white men.
Black patients have higher overall postoperative mortality than do white patients. To further understand this excess risk, researchers analyzed records for 1.8 million Black and white U.S. Medicare fee-for-service beneficiaries (age range, 65–99) who underwent any of eight common surgeries between 2016 and 2018; 30-day mortality outcomes were classified by race, sex, and surgical urgency (elective vs. nonelective).
After adjustment, Black men had significantly higher mortality than white men, white women, and Black women (3.05% vs. 2.69%, 2.38%, and 2.18%, respectively). These differences were driven primarily by deaths after elective procedures (1.30% vs. 0.85%, 0.82%, and 0.79%, respectively). No differences were observed for nonelective procedures.
CITATIONS
Ly DP et al. Inequities in surgical outcomes by race and sex in the United States: Retrospective cohort study. BMJ 2023 Mar 1; 380:e073290.
COMMENT
These disparities likely are attributable to a multitude of factors, including differential access to well-resourced hospitals and highly skilled surgeons, greater prevalence of chronic diseases and poorer chronic disease care, delays in surgical attention, differential responses to postoperative complications, and trust issues between patients and physicians. Evidence of the disparity following only elective procedures suggests that patient selection and preoperative optimization might play a role. All these factors potentially are fruitful areas for intervention and advocacy by primary care physicians.