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Study of risky surgeries finds racial disparity

October 25, 2006|Mary Engel | Times Staff Writer

Black, Latino and Asian patients are more likely than whites to have high-risk surgeries at California hospitals that have less experience doing the procedures, according to a study published today.

Less experienced hospitals, with a lower volume of cases, are widely believed to deliver poorer results.

The racial and ethnic disparities existed even when such factors as patients' income, insurance status and location were accounted for, according to the study in the Journal of the American Medical Assn.

Dr. David Satcher, director of the Center on Health Disparities at Atlanta's Morehouse School of Medicine and a former U.S. surgeon general, deemed the findings important but not surprising.

"This is another illustration of the inequalities in our healthcare system," he said.

The study also found that patients with no insurance or with Medi-Cal, California's insurance program for the poor, were more likely to be treated at low-volume hospitals than patients with private insurance or Medicare, the federal insurance program for the elderly.

The researchers -- from UCLA's David Geffen School of Medicine, the UCLA School of Public Health, the Rand Corp. and the West Los Angeles Veterans Affairs Medical Center -- used patient discharge data to look at 719,608 patients who received one of 10 operations at California hospitals from 2000 to 2004.

Of the 10 operations, pancreatic cancer surgery had the largest difference in mortality -- 3% compared with 13% -- between high- and low-volume hospitals.

Among all patients undergoing such surgery, blacks were 40% as likely and Latinos 46% as likely as whites to receive care in a high-volume hospital.

In another of the 10 operations -- hip fracture repair -- Asians were 62%, blacks 63% and Latinos 70% as likely as whites to use a high-volume hospital.

In an editorial accompanying the report, Dr. Samuel R.G. Finlayson of Dartmouth Medical School in New Hampshire examined some of the reasons for the disparities.

"The easiest explanations for why ethnic minority and poorly insured patients are less likely to use high-volume hospitals are that they cannot [because of barriers to access] or that they may not be aware of other options [because of lack of information]," Finlayson wrote. "These are real problems that society needs to address, but there is another possible explanation for why some patients do not go to high-volume hospitals -- they do not want to."

Finlayson wrote that minorities who have experienced discrimination sometimes choose a hospital based on its familiarity or on the ethnic or cultural makeup of the staff.

"Quality to a patient is a lot more than a lower surgical mortality rate, especially when the patient does not expect to die," he wrote.

Satcher said that simply moving everyone to high-volume hospitals was neither possible nor desirable.

"It's like saying, 'We're not going to fix healthcare in your community; we're going to take you where there's high volume and high quality,' " he said. "We need quality healthcare in all communities."

In 2003, Satcher led a task force on reforming the medical school associated with Los Angeles' long-troubled Martin Luther King Jr./Drew Medical Center, which serves a largely poor black and Latino community.

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mary.engel@latimes.com

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