The impact of rurality on racial disparities in costs of bowel obstruction treatment

Corynn Branche; Nikhil Chervu, MD MS; Giselle Porter, BS; Amulya Vadlakonda, BS; Sara Sakowitz, MS MPH; Konmal Ali; Saad Mallick, MD; Peyman Benharash, MD

Surgery Open Science (Aug 2024)

The impact of rurality on racial disparities in costs of bowel obstruction treatment

Corynn Branche,
Nikhil Chervu, MD MS,
Giselle Porter, BS,
Amulya Vadlakonda, BS,
Sara Sakowitz, MS MPH,
Konmal Ali,
Saad Mallick, MD,
Peyman Benharash, MD

Affiliations

Corynn Branche: David Geffen School of Medicine, University of California, Los Angeles, CA, USA
Nikhil Chervu, MD MS: Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA, USA
Giselle Porter, BS: David Geffen School of Medicine, University of California, Los Angeles, CA, USA
Amulya Vadlakonda, BS: David Geffen School of Medicine, University of California, Los Angeles, CA, USA
Sara Sakowitz, MS MPH: David Geffen School of Medicine, University of California, Los Angeles, CA, USA
Konmal Ali: David Geffen School of Medicine, University of California, Los Angeles, CA, USA
Saad Mallick, MD: David Geffen School of Medicine, University of California, Los Angeles, CA, USA
Peyman Benharash, MD: David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, UCLA, Los Angeles, CA, USA; Corresponding author at: UCLA Division of Cardiac Surgery, 62-249 Center for Health Sciences, Los Angeles, CA 90095, USA.

Journal volume & issue: Vol. 20
pp. 27 – 31

Abstract

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Background: Black race has been associated with increased resource utilization after operation for small bowel obstruction (SBO). While prior literature has similarly demonstrated differences between urban and rural institutions, limited work has defined the impact of rurality on resource utilization by race. Methods: The 2016–2020 National Inpatient Sample was used to identify adults undergoing adhesiolysis after non-elective admission for SBO. The primary endpoint was hospitalization costs. Additional outcomes included surgical delay (≥ hospital day 3), length of stay (LOS), and nonhome discharge. Regression models were developed to identify the impact of Black race and rurality on the outcomes of interest with an interaction term to examine the incremental association of Black race on rurality. Results: Of an estimated 132,390 patients, 11.4 % were treated at an annual average of 377 rural hospitals (18.5 % of institutions). After adjustment, rural hospitals had higher costs (β + $4900, 95 % Confidence Interval [CI] [4200, 5700]), compared to others. However, rurality was associated with reduced odds of surgical delay (Adjusted Odds Ratio [AOR] 0. 76, CI[0.69, 0.85]), decreased LOS (β −1.66 days, CI[−1.99, −1.36]), and nonhome discharge (AOR 0.78, CI[0.70, 0.87]). While White patients experienced significant cost reductions at urban centers ($26,100 [25,800-26,300] vs $31,000 [30,300-31,700]), this was not noted for Black patients ($30,100 [29,400-30,700] vs $30,800 [29,300-32,400]). Conclusions: We found that Black patients do not benefit from the same cost protection afforded by urban settings as White patients after operative SBO admission. Future work should focus on setting-specific interventions to address drivers of disparities within each community.

Published in Surgery Open Science

ISSN: 2589-8450 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://www.journals.elsevier.com/surgery-open-science/

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