Among older patients, black men may have a higher risk of dying within 30 days of surgery than their peers, a new study has found.
The study, published Wednesday in the medical journal BMJ, suggests that this inequity may be driven by outcomes after elective surgery, for which death was 50% higher in black men than in white men – information that may be helpful to physicians when planning procedures. for the sick.
Previously, separate research published in 2020 found similar results in children, showing that within 30 days of their surgery, black children were more likely to die than white children.
“While quite a lot is known about these inequalities, we find in our analyzes that it is specifically black men who die the most, and they die more after elective surgeries, not urgent and emergent surgeries,” said Dr. Dan Ly, assistant. professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at the University of California, Los Angeles, said in a press release.
“Our results point to possibilities such as lower pre-optimization of comorbidities prior to surgery, delays in care due to structural racism and physician bias, and increased stress and its associated physical burden on black men. in the United States,” Ly said. in the press release.
Researchers at the University of California, Los Angeles analyzed Medicare data on more than 1.8 million beneficiaries, ages 65 to 99, who had one of eight common surgeries. The data was from 2016 to 2018, and the researchers looked at the number of patients who died while in hospital or within 30 days of surgery.
The researchers found that the number of deaths after surgery was higher overall among black men than among white men, white women, and black women. Data suggests that death after surgery was 50% higher for black men than for white men after elective surgeries, but for non-elective surgeries there was no difference between black and white men , although mortality is lower for females of both races.
Of the black men in the study, about 3% died as a result of surgery, compared to 2.7% of white men, 2.4% of white women, and 2.2% of women black. These differences were relatively larger for elective surgeries and appeared within a week of surgery and persisted up to 60 days after surgery, the researchers found. In a separate analysis, the researchers found that Hispanic men and Hispanic women had lower overall mortality than black men.
“Our study shed light on the fact that black men experience a higher mortality rate after elective surgery than other race and gender subgroups. Further research is needed to better understand the factors contributing to this observation and to inform efforts to develop interventions that could effectively eliminate such a disparity,” said Dr. Yusuke Tsugawa, lead study author and associate professor of medicine at UCLA David Geffen School. of medicine, said in an email.
The study didn’t explore what might be driving the disparity, but Tsugawa said “several factors” could potentially play a role.
“Structural racism may at least partially explain our findings. For example, black patients living in predominantly black neighborhoods tend to live near hospitals that lack the resources to provide high-quality health care,” Tsugawa said in the email. “It is possible that black men in particular face particularly high cumulative amounts of stress and allostatic load, which refers to the cumulative burden of chronic stress and life events, potentially leading to a higher mortality rate. elevated after surgery in this population.”
The new study “validates” that racial inequalities exist in health care, said Dr. Georges Benjamin, executive director of the American Public Health Association, who was not involved in the study.
“Obviously, it’s concerning to see such a disparity,” Benjamin said, referring to the differences in the number of patients who died after surgery in the study results.
“Here’s another example that these disparities are real, and I think it helps let people know — doctors, health systems, providers — that the disparity is already there,” he said. “So when they consider providing surgical care to their patients, they need to be aware that statistically some of their patients may not be doing well 30 days after surgery, so they need to provide additional care. both providing care and understanding the condition of these patients when they undergo surgery.
The new study findings also raise many questions about healthcare systems and what happens when a patient is sent home after surgery and their ability to recover safely from a procedure, said Dr. Utibe Essien, assistant professor of medicine at the David Geffen School of Medicine at UCLA, who was not involved in the study.
“As a GP, I’m also thinking about that part and how we can engage with our fellow surgeons to ensure that our patients from underrepresented groups lead healthy lives after being under the knife so to speak. , “said Essien, adding that more research could help determine which types of elective surgeries may have experienced greater disparities than other types – and what would be needed to reduce the disparities.
“Would we find something different with more rare and complicated surgeries? It is possible and it comes down to the type of hospitals where patients receive their care,” Essien said.
“How connected is a hospital really to an academic medical center that knows the latest and greatest in surgical procedures? Do they have the technology to do truly innovative and safe work? ” he said. “I think it will be important to look at ways at the hospital level to address these disparities.”