Black and Hispanic patients are more likely to die after surgery than White patients, new research finds
Key Takeaways
Research presented at the American Society of Anesthesiologists’ 2023 annual meeting found that 42% of Black patients and 21% of Hispanic patients are more likely than White patients to die 30 days after surgery.
The research did not identify death's cause(s); however, researchers say that the deaths could have been avoided had disparities been eliminated.
Experts believe that systemic racism plays a role in patient health—not only at the hospital or after surgery but also over the course of a patient’s life.
Research presented at the American Society of Anesthesiologists’ 2023 annual meeting found that an estimated 12,000 Black and Hispanic patients who died after surgery in the last 20 years may have survived had racial and ethnic disparities not played a role.[][]
The researchers examined the Nationwide Inpatient Sample data of over one million inpatient surgeries performed on adults aged 18 to 64 years at nearly 8,000 hospitals in the United States between 2000 and 2020. They found that while adult mortality rates declined for all groups in the past two decades, Black and Hispanic patients still had higher mortality rates compared to white patients.
In fact, the team discovered that 42% of Black patients and 21% of Hispanic patients are more likely than White patients to die 30 days after surgery. Specifically, the researchers found that “About 24,561 (an average of 1,170 per year) excess post-surgical deaths occurred among Black and Hispanic patients, which could have been avoidable had the disparities been eliminated.”
These numbers were “driven by higher mortality in the Northeast (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont)” among Black patients and by “higher mortality in the West (Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington and Wyoming)” among Hispanic patients. Disparity gaps in mortality, the authors note, did not narrow over time.
The study did not identify the cause of death, nor did it assess the efficacy of specific interventions or policies that could have played a role in patient welfare.
“It’s important to note that disparities in these regions do not necessarily mean that the surgical care is inferior. It may reflect overall population health and socioeconomic conditions…Our team is currently investigating the underlying causes of these regional variations,” Christian Mpody, MD, PhD, MBA, the lead author of the study and Assistant Professor of Anesthesiology and Pediatrics at the Ohio State University College of Medicine, Columbus, said in a press release.[]
The researchers note that in order to achieve parity with White patients, Black patients must experience 8,364 fewer deaths, while Hispanic patients must experience 4,388 fewer deaths.
This research builds on similar findings from other studies. Earlier this year, research published in the Canadian Journal of Anesthesia found that “Hispanic and Black patients in the U.S. receive disproportionate anesthesia-related cares during their peripartum period, including anesthetic choice for cesarean deliveries, postpartum pain management, and labor epidural utilization.”[]
Yet another 2023 study found that US hospital financing assigns a lower dollar value to the care of Black patients, which could play into disparities in patient care.[]
Additionally, research in the Journal of General Internal Medicine found that, compared with White patients, Hispanic patients have demonstrated mistrust of healthcare providers and lower satisfaction with the care they receive.[]
Why do these gaps exist?
Dr. Leslie Farrington, MD, a former OB/GYN, Co-founder and Vice President of the Black Coalition For Safe Motherhood, Inc, and a Member of the Board of Directors at the Pulse Center for Patient Safety Education & Advocacy, tells MDLinx that it’s hard to know what elements may have culminated in these post-surgical patient deaths, but that various layers of systemic racism and bias are at play.
“There’s a combination of the healthcare worker bias as well as the impact of racism on the body when [patients] come in for surgery. You don't know if it's the doctor not caring or if the patient is impacted over their life course by the various ways racism affects us,” she says.
For example, she says, Black patients, in particular, often live in areas where factory pollutants are the norm. At the same time, other issues include lack of transportation to medical care, insurance access, and the stress of racism itself.
Sharon G.E. Washington, EdD., MPH, Founder of Sharon Washington Consulting, an organization that aims to eliminate inequities within healthcare organizations and the communities they serve, agrees.
Washington tells MDLinx that healing is simply a greater struggle when access to everyday needs is so limited. “Black, Latino, and Indigenous communities disproportionately bear the burden of intergenerational poverty, community segregation, housing instability, and food disparities,” she says. “These critical factors for post-surgery healing and recovery are systematically lacking within communities of color.”
Washington adds that post-surgical mortality isn’t the only issue. “The stark disparities in infant and maternal mortality, life expectancy, and the unequal prescription of pain medication all underscore systemic, institutional, and interpersonal manifestations of racism within the healthcare system,” she says. “These outcomes are also influenced by BIPOC communities' reluctance to access healthcare due to their experiences of racial discrimination and the fear of further discrimination.”
How can we begin to find a solution?
Dr. Mpody says that the problem of inequity requires a three-tiered approach that involves research, education, and service. The study details some of their ideas.
Washington also shares insight on what is needed: “Sustained policies, collaborative initiatives, and government support are essential for improving the social determinants of health within communities of color—critical steps toward dismantling the structural inequities that predispose marginalized patients to negative health outcomes,” she says. More so, she notes the need for continued collection and monitoring of race, ethnicity, and language data at both institutional and individual provider levels.
“Incorporating diverse patient cases with varying skin tones in case presentations and promoting racial and cultural diversity in case simulations are effective strategies for mitigating and re-educating against racial bias in training and education,” Washington continues.
And with studies demonstrating that women and Black physicians achieve better health outcomes among their patients, Washington also believes that prioritizing the diversification of physicians and healthcare workers is a means of promoting equity in healthcare.[][]
Dr. Farrington also says that while no single policy is going to change physician bias, policies should start with medical education that interrogates thinking around minority bodies being inferior.
“In the end, policies won't work unless they address capitalism, racism, and patriarchy as obstacles to improving healthcare,” Dr. Farrington says. “The only way to fix this [inequity] is for society to realize how the ideologies, thinking, and culture of white supremacy affect the healthcare of everyone. If we don't admit that we bring or have a bias, we are not going to fix this problem. The solution is to start to listen to people of color.”