Health care reform linked with reduced racial disparities in surgical care

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1. In Massachusetts, the probability of a nonwhite patient receiving minimally invasive surgery, rather than open surgery, increased after the enactment of health care reform in the state. 

2. In states without health care reform, the probability of minimally invasive surgery for white and nonwhite patients remained comparatively higher in the former. 

Evidence Rating Level: 2 (Good) 

Study Rundown: For acute cholecystitis and appendicitis, minimally invasive surgery (MIS) leads to fewer complications, faster recovery, and shorter hospital stays. However nonwhite patients, when compared to white and privately insured patients, have a higher probability of receiving open surgery. The authors analyzed large patient databases (n = 167 560) from Massachusetts and six other control states, specifically comparing government-subsidized, uninsured white patients to government-subsidized, uninsured nonwhite patients. The study included white, black, and Hispanic patients aged 18-64 who underwent procedures for either cholecystitis or appendicitis. Using an ordinary least squares regression model, the authors found no significant difference between white and nonwhite patients in the probability of receiving MIS after health care reform in Massachusetts. Prior to enactment, non-white patients were significantly less likely to receive MIS. Of note, generalizing these results across other states may not be accurate as health systems vary significantly across the nation.

Click to read the study in JAMA Surgery

Relevant Reading: Laparoscopic Cholecystectomy vs Open Cholecystectomy in the Treatment of Acute Cholecystitis

In-Depth [retrospective cohort]: This study compared the probability of receiving MIS for cholecystitis or appendicitis in white and nonwhite patient populations. Before health care reform in Massachusetts, nonwhite patients had a 5.21 percentage point lower probability of MIS than similar white patients (P < .001). After reform, nonwhite patients had a .06 percent higher probability of receiving MIS than the white patient group (P < .96). In the six control states, nonwhite patients were 1.39 points less likely to receive MIS (P = .007). At the time of health care reform in Massachusetts, nonwhite patients in the control states were 3.19 points less likely to receive MIS (P = < .001). The data demonstrates a closing of the probability gap in Massachusetts after reform.

More from this author: Local excision inferior to major resection in T1-2 colon cancer and T2 rectal cancer, Secondary mastoid obliteration improves quality of life for patients with chronic otitis media 

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