Patient–surgeon racial and ethnic concordance and outcomes of older adults operated on by California licensed surgeons: an observational study

Abstract

OBJECTIVE: To examine the association of patient-surgeon racial and ethnic concordance with postoperative outcomes among older adults treated by surgeons with California medical licences. DESIGN: Retrospective cohort study. SETTING: US acute care and critical access hospitals in 2016-2019. PARTICIPANTS: 100% Medicare fee-for-service beneficiaries aged 65-99 years who underwent one of 14 common surgical procedures (abdominal aortic aneurysm repair, appendectomy, coronary artery bypass grafting, cholecystectomy, colectomy, cystectomy, hip replacement, hysterectomy, knee replacement, laminectomy, liver resection, lung resection, prostatectomy and thyroidectomy), who were operated on by surgeons with self-reported race and ethnicity (21.4% of surgeons) in the Medical Board of California database. We focused our primary analysis on black and Hispanic beneficiaries. PRIMARY OUTCOMES MEASURE: The outcomes assessed included (1) patient postoperative 30-day mortality, defined as death within 30 days after surgery including during the index hospitalisation, (2) 30-day readmission and (3) length of stay. We adjusted for patient, physician and hospital characteristics. RESULTS: Among 1858 black and 4146 Hispanic patients treated by 746 unique surgeons (67 black, 98 Hispanic and 590 white surgeons; includes surgeons who selected multiple backgrounds), 977 (16.3%) patients were treated by a racially or ethnically concordant surgeon. Hispanic patients treated by concordant surgeons had lower 30-day readmission (adjusted readmission rate, 4.2% for concordant vs 6.6% for discordant dyad; adjusted risk difference, -2.4 percentage points (pp); 95% CI, -4.3 to -0.5 pp; p=0.014) and length of stay (adjusted length of stay, 4.1 d vs 4.6 days (d); adjusted difference, -0.5 d; 95% CI, -0.8 to -0.2 d; p=0.003) than those treated by discordant surgeons. We found no evidence that patient-surgeon racial and ethnic concordance was associated with surgical outcomes among black patients or mortality among Hispanic patients. CONCLUSIONS: Patient-surgeon racial and ethnic concordance was associated with a lower postoperative readmission rate and length of stay for Hispanic patients. Increasing Hispanic surgeon representation may contribute to narrowing of racial and ethnic disparities in surgical outcomes.

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