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Comparative Study
. 2015 Jul;210(1):52-8.
doi: 10.1016/j.amjsurg.2014.08.025. Epub 2014 Oct 13.

Racial variation in the use of life-sustaining treatments among patients who die after major elective surgery

Roland A Hernandez  1 , Nathanael D Hevelone  2 , Lenny Lopez  3 , Samuel R G Finlayson  4 , Eva Chittenden  5 , Zara Cooper  6
Affiliations
Comparative Study

Racial variation in the use of life-sustaining treatments among patients who die after major elective surgery

Roland A Hernandez et al. Am J Surg. 2015 Jul.

Abstract

Background: Although various studies have documented increased life-sustaining treatments among racial minorities in medical patients, whether similar disparities exist in surgical patients is unknown.

Methods: A retrospective cohort study using the Nationwide Inpatient Sample (2006 to 2011) examining patients older than 39 years who died after elective colectomy was performed. Primary predictor variable was race, and main outcome was the use of life-sustaining treatment.

Results: In univariate analysis, significant differences existed in use of cardiopulmonary resuscitation (CPR; black, 35.9%; Hispanic, 29.0%; other, 24.5%; white, 11.7%; P = .002) and reintubation (Hispanic, 75.0%; other, 69.0%; black, 52.3%; white, 45.2%; P = .01). In multivariate analysis, black (odds ratio [OR], 3.67; P = .01) and Hispanic (OR, 4.21; P = .03) patients were more likely to have undergone CPR, and Hispanic patients (OR, 4.24; P = .01) were more likely to have been reintubated (reference: white).

Conclusions: Blacks and Hispanics had increased odds of experiencing CPR, and Hispanics were more likely to have been reintubated before death after a major elective operation. These variations may imply worse quality of death and increased associated costs.

Keywords: End-of-life care; Life-sustaining treatment; Quality of death; Racial disparities.

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