Research Activities, March 2014
Disparities still persist in surgical outcomes of low-income patients
Over the past 20 years, major strides have been made in improving patient safety and surgical outcomes. Postoperative mortality has decreased for a number of high-risk cardiovascular procedures and cancer-related surgeries, there are fewer failures to rescue from surgical complications, and a number of postoperative complications have improved. Yet, disparities in surgical outcomes continue for low-income patients, concludes a new study. AHRQ researcher Roxanne M. Andrews, Ph.D., and Mehwish Qasim, a doctoral candidate of the University of Iowa, found that patients living in low-income areas had worse surgical outcomes than residents of high-income areas on 9 of 12 measures, and lower rates of postoperative hemorrhage and hematoma.
The researchers used AHRQ's Healthcare Cost and Utilization Project Nationwide Inpatient Sample data for 2000 and 2009 to examine differences between patients from low- and high-income communities on 12 surgical outcome measures. They examined in-hospital mortality rates for patients undergoing one of eight surgical procedures: abdominal aortic aneurysm repair, heart bypass graft, carotid endarterectomy, craniotomy, esophageal cancer resection, hip replacement, pancreatic cancer resection, and coronary artery stenting. Nearly all postsurgical mortality measures improved for all patients from 2000 to 2009. Still, low-income patients experienced worse outcomes for most surgical mortality measures.
In 2000 and 2009, patients living in low-income communities scored significantly worse on six of the eight mortality measures. The only two exceptions were carotid endarterectomy and esophageal resection. In the case of hip replacement, low-income patients had a mortality rate 26 percent higher than patients from high-income areas. During the study period, overall mortality was reduced by at least 10 percent for each measure. For both 2000 and 2009, the low-income group had significantly higher rates of three of the four post-surgical complications examined: death following treatable complication, postoperative respiratory failure, and postoperative wound dehiscence (where the wound ruptures along the suture line).
See "Despite overall improvement in surgical outcomes since 2000, income-related disparities persist," by Mr. Qasim and Dr. Andrews in the October 2013 Health Affairs 32(10), pp. 1773-1780. Reprints (AHRQ Publication No 14-R011) are available from AHRQ.