The effect of race on postsurgical ambulatory medical follow-up among United States Veterans

• Published in: Journal of clinical anesthesia 2017-08, Vol.40, p.55-61
• Main Authors: Schonberger, Robert B., MD, MHS, Dai, Feng, PhD, Brandt, Cynthia, MD, MPH, Burg, Matthew M., PhD
• Format: Article
• Language: English
• Subjects: Adult; African Americans; Aged; Ambulatory care; Ambulatory Care - statistics & numerical data; Anesthesia; Anesthesia & Perioperative Care; Anesthesiology; Black or African American - psychology; Black or African American - statistics & numerical data; Comorbidity; Continuity of Patient Care - statistics & numerical data; Ethnicity; Female; Follow-Up Studies; Health care; Healthcare Disparities - ethnology; Healthcare Disparities - statistics & numerical data; Hospital administration; Humans; Hypertension; Internal medicine; Long-Term Care - statistics & numerical data; Male; Middle Aged; Mortality; Pain Medicine; Patient Acceptance of Health Care - ethnology; Patient Acceptance of Health Care - statistics & numerical data; Patients; Public health; Race; Racial differences; Retrospective Studies; Risk factors; Studies; Surgery; Surgical Procedures, Operative - rehabilitation; United States; Veterans; Veterans Health - statistics & numerical data; Young Adult
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2016.11.002

Abstract Study objective To investigate the association between self-identified black or African American race and the presence of ambulatory internal medicine follow-up in the year after surgery. Our hypothesis was that among US Veterans who presented for surgery, black or African American race would be associated with a decreased likelihood to receive ambulatory internal medicine follow-up in the year after surgery. Design Retrospective observational. Setting All US Veterans Affairs hospitals. Patients A total of 236,200 Veterans undergoing surgery between 2006 and 2011 who were discharged within 10 days of surgery and survived the full 1-year exposure period. Interventions None. Measurements Attendance at an internal medicine follow-up appointment within 1 year after surgery. Main results After controlling for year of surgery, age, age ≥65 years, sex, Hispanic ethnicity, and number of inpatient days, black or African American patients were 11% more likely to lack internal medicine follow-up after surgery (adjusted odds ratio, 1.11; 95% confidence interval, 1.06-1.16). When accounting for geographic region, this difference remained significant at the Bonferoni-corrected P < .007 level only in the Midwest United States where black or African American patients were 28% more likely to lack medical follow-up in the year after surgery (odds ratio, 1.28; 95% confidence interval, 1.16-1.42; P < .0001). Conclusions The disparity in ambulatory medical follow-up following surgery among black or African American vs nonblack or non–African American Veterans in the Midwest region deserves further study and may lead to important quality improvement initiatives aimed specifically at this population.