While racial/ethnic disparities in outcomes have been well-documented throughout the field of medicine, there is minimal evidence examining such disparities among thoracic surgery patients. In order to begin to identify potential disparities within our integrated health care system, we evaluated 30-day readmission, 30-day mortality, and length of stay by race/ethnicity among a large population of thoracic surgery patients.
Our integrated health system serves as a regional referral center and treats a large volume of thoracic surgery patients. We reviewed all thoracic surgery patients from January 1, 2016 through December 31, 2020 within this institution. Patients were included if they had undergone any thoracic surgery including open, video assisted thoracoscopic surgery, and robot-assisted surgery. Patients were excluded if they were not managed by the thoracic surgery service while inpatient. Baseline demographics of age, sex, and race/ethnicity as well as outcomes of 30-day readmission, 30-day mortality, and hospital length of stay were collected. We performed chi-square tests and Kruskal-Wallis tests to compare outcomes between racial/ethnic groups for categorical and non-normally distributed quantitative data, respectively. Multiple linear regression was performed to test for significant predictors of length of stay.
Overall, 2,885 patients were included in our study period. On average, these patients were 63.0 years of age (standard deviation, 14.9) and 51.7% were male. The race/ethnicity breakdown of the cohort was 59.6% non-Hispanic White, 14.8% Asian, 12.0% Hispanic, 9.4% Black, and 4.2% other. The average 30-day readmission rate was 12.4% and did not differ by race/ethnicity (p=0.70). The average 30-day mortality was 1.7% and similarly did not differ by race/ethnicity (p=0.82). However, hospital length of stay differed by race/ethnicity with Asian and Black patients experiencing approximately 15 hours longer length of stay on average (p<0.01). On multiple linear regression analysis, Asian (adjusted beta coefficient 15.2, 95% CI 1.53-28.8) and Black (adjusted beta coefficient 29.7, 95% CI 13.3-46.2) patients had significantly prolonged length of stay (compared to non-Hispanic White patients), adjusting for age and sex.
Among all thoracic patients within our integrated health system, 30-day readmission and 30-day mortality were not different; however, length of stay was found to be longer among Asian and Black patients, and these differences in length of stay remained significant for Asian and Black race on multivariable analysis after adjusting for age and sex. Analysis of potential race/ethnicity disparities are critical and these findings in a large population of thoracic surgery patients lay groundwork to begin to understand the underlying causes for these disparities as well as ways to improve them.