S. Mallick1, S. Sakowitz1, S. Bakhtiyar1,2, S. Kim1, J. Hadaya1, J. Curry1, P. Benharash1,3 1David Geffen School Of Medicine, University Of California At Los Angeles, Cardiovascular Outcomes Research Laboratories, Los Angeles, CA, USA 2University Of Colorado Denver, Department Of Surgery, Aurora, CO, USA 3David Geffen School Of Medicine, University Of California At Los Angeles, Department Of Surgery, Los Angeles, CA, USA
Introduction:
Racial health disparities are responsible for $50 billion in excess annual healthcare expenditures, driven in part by unequal access to preventive services. A national comparison of the excess financial strain of urgent vs. planned surgical procedures across various racial groups is lacking. We thus studied cost differences in abdominal aortic aneurysm repair (AAA), coronary artery bypass graft (CABG), and colectomy for neoplasm (COL), as the elective status of these procedures suggest greater access to preventive care and screening.
Methods:
All adult (≥18 years) hospitalizations for AAA, CABG, and COL were identified using the 2016-2020 National Inpatient Sample. Multivariable models were developed to assess cost differences for emergent versus elective surgeries across different racial groups. Racial differences in adjusted odds of undergoing emergent surgery were likewise determined.
Results:
Of an estimated 1,434,235 records, 625,579 (43.6%) comprised emergent operations. Specifically, 41.5% of AAA, 51.4% of CABG, and 28.8% of COL were nonelective. Stratifying by race, 42% of White patients were operated on emergently compared to 48% of Black, 51.2% of Hispanic, and 45.9% of Asian/Pacific Islander (API) patients. After risk adjustment, Black (AOR 1.15, CI 1.12-1.18), Hispanic (AOR 1.35, CI 1.31-1.39) and API (AOR 1.18, CI 1.13-1.23) patients demonstrated increased odds of undergoing emergent surgery relative to White patients.
The average cost of elective surgery was $35,692(CI 35331-36053) for White patients, $32,911(CI 32191-33632) for Black, $38,798(CI 37842-39754) for Hispanic, and $44,061(CI 42298-45823) for API patients. The adjusted mean cost difference for emergent procedures relative to elective was $12,842(CI 12477-13206) for White, $16,038(CI 15021-17054) for Black, $13,825(CI 12648-15002) for Hispanic, and $18,930(CI 16714-21145) for API patients (Figure). Following adjustment, Black(β $3,167 CI 2199-4135), Hispanic(β $5,521 CI 4398-6645), and API(β $14,209 CI 12135-16283) patients faced incrementally increased hospitalization costs for emergent surgery relative to White patients (all p<0.001). If just 10% of these emergent procedures had been performed electively, the cost benefit would have been $849,349,966 over 5 years.
Conclusion:
Emergent surgery is associated with increased costs differences amongst all minority races. Further, a modest 10% decrement in emergency procedures would lead to cost savings of ~$170 million annually, nearly double estimates from the early 2000s. Given these operations could be performed electively with advance planning, enhanced care coordination and access to preventative screening is needed to ameliorate pervasive racial disparities and reduce costs.
