Black men at higher risk of dying after surgery than White men, or women of either race: BMJ

USA: Black men experience higher mortality after elective procedures compared with White men, Black women, and White women, a recent study published in The BMJ has shown.

The findings underscore the need to understand better the unique challenges Black men who need surgery face.

This inequality in death rate was mainly observed for elective or planned surgeries, where the death rate for Black men was 50% higher than that of White men. The researchers say further research is needed to understand better the “factors contributing to this higher mortality rate among Black men after elective surgery.”

In previous studies, racial inequities in surgical care and outcomes, including a higher death rate following surgery for Black patients, have been well documented.

However, less is known about how surgical outcomes differ by the race and sex of patients undergoing elective or non-elective (urgent or emergency) surgeries.

To fill in this knowledge gap, the researchers used nationwide Medicare data on 1,868,036 adults with an average age of 75 years who underwent one of eight surgeries-abdominal aortic aneurysm repair, appendectomy, cholecystectomy, colectomy, coronary artery bypass surgery, hip replacement, knee replacement, and lung resection-between 2016–2018.

They analysed data for differences in death rates between subgroups of race and sex following elective or urgent surgeries

Of the adults included in this study, 40.7% were White men, 53.4% were White women, 2.2% were Black men, and 3.7% were Black women. Just over 70% of the surgeries were elective.

After accounting for other potentially influential factors such as age, disability, and a range of underlying chronic conditions, the researchers found that Black men had a higher death rate (3.05%) within 30 days of both urgent and elective surgery than White men (2.69%), White women (2.38%), and Black women (2.18%).

A similar pattern was found for elective surgery: Black men had a higher death rate (1.3%) than White men (0.85%), White women (0.82%), and Black women (0.79%).

This 0.45 percentage point difference between Black and White men “implies that mortality after elective procedures was 50% higher in Black men compared with White men", say the researchers.

And much of this difference persisted even when patients operated on by the same surgeon were compared, they note.

The researchers did not find a statistically significant difference between Black and White men following urgent surgery, with death rates of 6.69% and 7.03%, respectively.

However, they found that deaths after urgent surgery were lower for White and Black women than men of either race, at 6.12% and 5.29%, respectively.

This is an observational study, so it cannot establish cause. The researchers acknowledge that their results were limited to Black and White Medicare patients undergoing certain procedures, so they may not apply to other groups or types of surgery.

However, results remained largely unchanged after further sensitivity analyses, suggesting they are robust.

The researchers suggest that structural racism within society, such as higher rates of poverty among Black patients, which can lead to poorer underlying health and challenges accessing care, may, at least partially, explain their findings and say better standardisation of care is needed to help mitigate some of these factors and reduce inequities in surgical outcomes.

“Further research is needed to understand better the preoperative, intraoperative, and postoperative factors contributing to this higher mortality rate among Black men after elective surgery, ” they conclude.

Reference:

Dan P Ly, Mariah B Blegen, Melinda M Gibbons, Keith C Norris, Yusuke Tsugawa BMJ 2023; 380 doi: https://doi.org/10.1136/bmj-2022-073290