Micah Girotti1, Jonathan L. Eliason2, Justin B. Dimick1, Peter K. Henke2
1University of Michigan, Department of Surgery, Center for Healthcare Outcomes and Policy, Ann Arbor, MI; 2University of Michigan, Department of Surgery, Section of Vascular Surgery, Ann Arbor, MI.
OBJECTIVES: Black patients are disadvantaged in many aspects of vascular surgical care compared to non-blacks, such as postoperative mortality and receipt of endovascular procedures. We sought to examine whether these racial disparities extend to rates of postoperative readmission.
METHODS: National Medicare beneficiaries undergoing major vascular surgery (open abdominal aortic aneurysm repair (AAAR) and lower extremity bypass (LEB)) in 2000-2008 were examined (n=387,501). Risk-adjusted 30-day readmission was the primary outcome measure. Logistic regression was used to adjust for patient factors. After ranking hospitals by proportion of black patients served, differences in readmission rates were examined. Finally, the impact of the site of care on the observed disparity was assessed by using modeling techniques that adjust for hospital-specific readmission differences.
RESULTS: After adjusting for patient factors, blacks were 20% more likely than non-blacks to be readmitted. Black patients receiving care in predominantly minority-serving hospitals were readmitted more often than black patients in non-minority-serving hospitals (19.9% vs. 14.2%, p=<.001). In models accounting for differences in site of care, the hospitals where black patients receive care accounted for approximately 55% of the residual disparity in readmission rates. This magnitude of this effect was similar for both operations (34% in AAAR, 56% in LEB).
CONCLUSIONS: Black patients are more likely to be readmitted to the hospital following major vascular surgery compared to non-black patients. Higher readmission rates in minority-serving hospitals play an important role in this observed disparity. Whether patient-level factors or hospital-level processes contribute will require further study.
AUTHOR DISCLOSURES: J. B. Dimick, Nothing to disclose; J. L. Eliason, Nothing to disclose; M. Girotti, Nothing to disclose; P. K. Henke, Nothing to disclose.
Posted April 2012