Disparate use of minimally invasive surgery in benign surgical conditions

Surg Endosc. 2008 Sep;22(9):1977-86. doi: 10.1007/s00464-008-0003-0. Epub 2008 Jul 2.


Background: Disparities in outcome across race and ethnicity have been consistently described for medical and surgical care. Given that surgery is a rapidly evolving field, we hypothesized that racial disparities exist in access to minimally invasive surgery (MIS), which importantly influences outcome.

Methods: Cohort analysis of all patients who underwent appendectomy, gastric fundoplication, and gastric bypass in the Nationwide Inpatient Sample, a 20% stratified random sample of US hospital discharge abstracts. To determine the effect of race on the use of MIS techniques and morbidity and mortality, we controlled for patient characteristics, comorbidity, and hospital characteristics including surgical volume and MIS conversion to open surgery.

Results: Blacks were consistently less likely to be treated with MIS despite adjustment for socioeconomic status, comorbidity, and treatment setting. In addition, in-hospital mortality and complications such as pneumonia, heart disease, infections, and surgical misadventures were higher in black than white patients. These outcomes differences remained despite adjustment for hospital volume, the use of MIS, and MIS conversion to open surgery.

Conclusions: We demonstrate evidence of racial disparities in the use of MIS for benign surgical conditions and worse outcomes for patients of black race. Although, the racial differences in outcome were attenuated with adjustment for MIS, further studies are needed to help resolve remaining differences in outcomes across race.

MeSH terms

  • Appendectomy / methods
  • Appendectomy / statistics & numerical data*
  • Black or African American / statistics & numerical data
  • Cohort Studies
  • Comorbidity
  • Female
  • Fundoplication / methods
  • Fundoplication / statistics & numerical data*
  • Gastric Bypass / methods
  • Gastric Bypass / statistics & numerical data*
  • Healthcare Disparities / statistics & numerical data*
  • Hospital Mortality
  • Hospitals / statistics & numerical data
  • Humans
  • Income / statistics & numerical data
  • Insurance, Health, Reimbursement / statistics & numerical data
  • Laparoscopy / statistics & numerical data*
  • Laparotomy / statistics & numerical data
  • Male
  • Minimally Invasive Surgical Procedures / statistics & numerical data*
  • Patient Discharge / statistics & numerical data
  • Postoperative Complications / epidemiology
  • Racial Groups / statistics & numerical data*
  • Socioeconomic Factors
  • Treatment Outcome
  • United States