• Kevin Fiscella, Peter Franks, Sean Meldrum, and Steven Barnett.
• Department of Family Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA. Kevin_Fiscella@URMC.rochester.edu
• Ann. Surg. 2005 Aug 1; 242 (2): 151155151-5.

ObjectiveTo examine the relationship between race and surgical complications.Summary Background DataBlacks have been reported to experience higher rates of surgical complications than whites, but the reasons are not known.MethodsThe effect of the black race on risk of any surgical complication (from the Agency for Healthcare Research and Quality's patient safety indicators) was examined using New York State (NYS) hospital discharge data from 1998 to 2000. Sequential, hierarchical analyses controlled for: 1) patient age and gender, 2) morbidity length of stay, 3) individual social factors, 4) hospital characteristics, and 5) ecologic factors (region of state, percent black and Medicaid annual discharges, and mean income of admitted patients).ResultsFollowing adjustment for patient age and gender, blacks had 65% higher odds for a surgical complication. Further adjustment for comorbidity and length of stay (LOS) reduced the odds substantially to 1.18. Additional adjustment for American Hospital Association hospital characteristics essentially eliminated the risk. Final adjustment for hospital ecologic variables reduced the odds to 1.0.ConclusionsHigher rates of surgical complications among blacks than whites in NYS are primarily explained by differences in comorbidity LOS and the hospital where the surgery occurred.

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