The Impact of Race on the Surgical Management of Adhesive Small Bowel Obstruction
*Alexander S Chiu, Raymond A Jean, Kimberly A Davis, *Kevin Pei
Yale School of Medicine, New Haven, CT
Objective: Adhesive small bowel obstruction (SBO) accounts for 15% of surgical admissions. Although some obstructions resolve without surgical intervention, many require adhesiolysis. Both duration of expectant management and eventual operative approach (laparoscopic versus open) varies in practice, and it is unknown if racial biases influence these decisions. Design: Retrospective analysis of the American College of Surgeons NSQIP database Setting: Participating hospitals between 2010-2015 Patients: 14,626 patients older than 18 years with a diagnosis of adhesive obstruction who underwent laparoscopic or open adhesiolysis, with or without small bowel resection Main Outcome Measures: Adjusted logistic regression models of adhesiolysis within 5 days from hospital admission (Eastern Association for the Surgery of Trauma guidelines) and of undergoing a laparoscopic operation Results: A greater percentage of Black patients waited longer than 5 days for an operation (14.84% vs. 10.82%, p<0.001) and underwent open adhesiolysis (77.84% vs. 69.44%, p<0.001) compared to White patients. Regression analysis incorporating patient comorbidity, ASA class, and emergency status demonstrated that Black patients were significantly more likely than White patients to wait longer than 5 days for surgery (OR 1.35 [CI 1.15-1.58]) and less likely to undergo laparoscopic surgery (OR 0.62 [CI 0.53-0.72]). There was no statistical difference for Hispanic patients waiting greater than 5 days (OR 1.02 CI [0.76-1.38]) or receiving laparoscopic surgery (OR 1.17 CI [0.95-1.44]) compared to White patients. Conclusions: Black patients are significantly more likely than White patients to wait longer than recommended for adhesiolysis and less likely to undergo laparoscopic surgery for SBO. While the data are limited by lack of socioeconomic and hospital-level information, the results suggest that patient race may influence the surgical management of SBO.
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