Ahead of Print: Racial and Socioeconomic Disparities in Incidence of Hospital Acquired Complications

Background: Patients with cerebrovascular disease undergo complex surgical procedures, often requiring prolonged inpatient hospitalization. Prior studies have demonstrated associations between racial/demographic factors and clinical outcomes in patients undergoing cerebrovascular procedures (CVPs). The Centers for Medicare and Medicaid Services (CMS) have published a series of 11 hospital-acquired conditions (HACs) deemed “reasonably preventable” for which related costs of treatment are not reimbursed. We hypothesize that race and payer status disparities impact HAC frequency in patients undergoing CVPs and that HAC incidence is associated with length of stay and hospital costs.

Objective: To assess health disparities in HACs among the cerebrovascular neurosurgical patient population.

Methods: Data were collected from the Nationwide Inpatient Sample (NIS) database from 2002-2010. CVPs and HACs were identified by ICD-9CM diagnostic and procedure codes. HAC incidence was evaluated according to demographics including race, payer status, and median zip code income via multivariable analysis. Secondary outcomes of interest included length of stay and resulting inpatient charges.

Results: From 2002-2010, there were 1,290,883 CVP discharges with an HAC rate of 0.5%. Significant disparities in HAC frequency existed according to ethnicity and insurance provider. Minorities and Medicaid patients had increased frequency of HACs (p<0.05), as well as prolonged length of stay and higher inpatient costs (p<0.05).

Conclusion: HAC incidence is associated with racial and socioeconomic factors in patients who undergo CVPs. Awareness of these disparities may lead to improved processes and protocol implementation, which might help to decrease the frequency of these potentially avoidable events.

From: Racial and Socioeconomic Disparities in Incidence of Hospital Acquired Complications Following Cerebrovascular Procedures by Wen et al.

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