A new analysis of more than 1.5 million inpatient hospital procedures in the United States has revealed that Black and Hispanic patients die at a substantially higher rate after surgery than white patients.
According to the findings, presented this week at the annual meeting of the American Society of Anesthesiologists in San Francisco, the likelihood of death within 30 days after surgery is 42 percent higher for Black people and 21 percent higher for Hispanic people.
Researchers estimated that about 12,000 minority patients who died after surgery over the past two decades may have lived if there were no racial and ethnic disparities among Americans having surgery.
“Although we saw post-surgery mortality decline for all groups, people are still dying every day because of persistent disparities in surgical health in the United States, and if we do not intensify efforts to reduce this disparity, people are going to continue to die,” says the lead study author, Christian Mpody, MD, an assistant professor of anesthesiology and pediatrics at the Ohio State University College of Medicine in Columbus.
For the investigation, Dr. Mpody and his team reviewed data from about 1.5 million surgical procedures among adults ages 18 to 64. The surgeries were performed at about 8,000 U.S. hospitals between 2000 and 2020. Three-quarters of the patients in the study were white, 14 percent were Hispanic, and 11 percent were Black.
The scientists identified the Northeast as the region in the United States with higher deaths among Black people and the West as the area with more deaths among Hispanic people.
What’s Behind the Differences in Post-Surgery Outcomes
The study, which is being published in the December 2023 edition of the Annals of Surgery Open, notes that surgical care is not necessarily inferior in these parts of the country. Although Mpody and his colleagues are currently investigating the underlying causes of these regional variations, they speculate that population health or social and economic conditions — for example, lower incomes and lack of education — may be tied to the higher death rates.
A deeper examination may “underscore the impacts of systematic underinvestment in public health, unequal access to primary healthcare services, and distrust in the healthcare industry created by historical and enduring structural racism and medical mistreatment of minoritized groups,” the researchers wrote.
“I agree with the authors that the reasons for these disparities are most likely structural,” says Fatima Rodriguez, MD, MPH, an associate professor of cardiovascular medicine at Stanford Health Care in California. Dr. Rodriguez’s research focuses on racial, ethnic, and gender disparities in cardiovascular disease prevention.
“We should address structural factors, including racism, and improve the quality and resources at facilities where minoritized patients receive their care,” says Rodriguez. “Everyone deserves the opportunity to experience good surgical outcomes.”
Health disparities extend far beyond surgery-related deaths. Data from the Centers for Disease Control and Prevention (CDC) show that racial and ethnic minority groups throughout America experience higher rates of illness across a wide range of health conditions, including diabetes, high blood pressure, obesity, asthma, and heart disease, compared with their white counterparts.
Rodriguez, who was not involved in the new study, has worked on previous research identifying high hospitalization rates for acute high blood pressure among Black people. Similar to the current study, that work recognized the lack of progress in reducing racial disparities in hospitalizations, and highlighted the need for new approaches to address both medical and nonmedical factors that contribute to such disparities.
Possible Solutions to a Long-Standing Problem
Mpody and his colleagues suggest that efforts to narrow this racial and ethnic gap in surgical outcomes may include:
- Increasing access to healthcare
- Enhancing cultural competency training for healthcare professionals
- Promoting diversity in the healthcare workforce
- Addressing social and economic factors such as insurance coverage and social support
- Fostering research and data collection on healthcare disparities
If such measures could produce even a 2 percent reduction in projected excess mortality rates among Black patients, the researchers predicted that roughly 3,000 post-surgery deaths could be prevented in the next decade.
Mpody stresses the real human toll behind these numbers.
“We should not become used to reading statistics about people dying,” he says. “It’s essential to remember that beyond the statistics, there are real people — brothers, sisters, mothers, and fathers. There are families and communities that are torn apart. It’s important to convey the gravity of the issue to policymakers, healthcare professionals, and the general public.”