Table 4:
Receipt of Optimal Care Measures of Surgical Access Disparities
| Measure of surgical access disparity | Disparity group examined | Surgical specialty |
|---|---|---|
| Proportion of early-stage, unilateral breast cancer patients receiving breast reconstruction after mastectomy | Racial/ethnic (48–56); insurance (48, 50, 52, 54–56) ; geography (48, 57); income (50, 54); education (50, 51) |
General |
| Proportion of patients receiving breast reconstruction during the same hospitalization (i.e. immediately) after mastectomy | Insurance (152, 207); racial/ethnic (77, 78); income (77); education (77) |
General |
| Proportion of stage 0 to ii unilateral breast cancer patients receiving contralateral prophylactic mastectomy | Racial/ethnic (208) | General |
| Ratio of mastectomies performed in outpatient vs. Inpatient settings | Racial/ethnic (209) | General |
| Proportion of patients with hepatocellular carcinoma who undergo bridging locoregional therapy among all patients who receive an orthotropic liver transplant | Racial/ethnic (210); education (210); insurance (210) |
General |
| Proportion of patients with soft tissue sarcoma who receive limb sparing surgery | Racial/ethnic (211, 212) | Orthopedic |
| Proportion of patients with ovarian cancer undergoing bowel resection, peritoneal biopsy/omentectomy | Racial/ethnic (111) | Gynecologic oncology |
| Proportion of gastric cancer patients with surgically treated gi malignancy receiving “adequate lymphadenectomy” (more than 15 esophagus, 15 stomach, 12 small bowel, 12 colon, 12 rectum, and 15 pancreas) | Income (58) | General |
| Proportion of lung cancer patients receiving appropriate lymph node resection | Racial/ethnic (59) | Thoracic |
| Stage-adjusted proportion of lung cancer patients receiving appropriate lymph node resection | Racial/ethnic (59) | Thoracic |
| Proportion of ovarian cancer patients who have the recommended number of lymph nodes removed | Racial/ethnic (111) | Gynecologic oncology |
| Proportion of breast cancer patients who have the recommended number of lymph nodes removed | Racial/ethnic (76) | General |
| Proportion of patients with gastric cancer who have the recommended number of lymph nodes removed | Insurance (213) | General |
| Proportion of patients localized/regional prostate cancer who have the recommended number of lymph nodes removed | Racial/ethnic (214) | Urology |
| Proportion of pediatric patients presenting to the emergency department with abdominal pain who received abdominal ct imaging to confirm appendicitis | Racial/ethnic (46) ; insurance (46) |
General |
| Proportion of patients with end-stage renal disease who have an arteriovenous fistula at initial hemodialysis | Racial/ethnic (215) | Vascular |
| Proportion of patients with acute cholecystitis who receive immediate cholecystectomy | Insurance (60) ; racial/ethnic (60) |
General |
| Proportion of all patients admitted for acute ischemic stroke who receive reperfusion on the first admission day, invasive angiography, and operative procedures including carotid endarterectomy | Income (216) | Neurological |
| Proportion of all carotid endarterectomy surgeries with inappropriate clinical indicators (high comorbidity in asymptomatic patient, operating in a setting of a recent or severe disabling stroke, minimal stenosis, operating contralateral to symptoms, occluded artery) | Racial/ethnic (41) | Vascular |
| Proportion of patients with lower extremity fractures (open tibial/fibular and femoral fractures) who undergo amputations | Racial/ethnic (61) | Orthopedic |
| Proportion of patients with graves’ disease who receive a thyroidectomy | Income (217) | General |
| Proportion of patients presenting with blunt injuries with pelvic fractures who receive diagnostic procedures (vascular ultrasound, ct of the abdomen), transfusions, venous pressure monitoring, and arterial catheterization for embolization | Insurance (218) | General |
| Proportion of patients with symptomatic heart failure who receive biventricular pacing | Racial/ethnic (219); income (219); insurance (219) |
Thoracic |
| Proportion of patients undergoing major elective orthopedic surgery who receive autologous blood transfusion | Insurance (220); income (220); racial/ethnic (220) |
Orthopedic |
| Proportion of patients receiving laparoscopic vs. Open hysterectomies | Racial/ethnic (63) | Obstetrics & gynecology |
| Proportion of patients receiving laparoscopic vs. Open hysterectomies for the indication of fibroids | Racial/ethnic (64) | Obstetrics & gynecology |
| Proportion of patients receiving laparoscopic vs. Open hysterectomy for uterine cancer | Racial/ethnic (113) | Gynecologic oncology |
| Proportion of breast cancer patients who receive breast conservation surgery vs. Mastectomy | Insurance (18, 21); racial/ethnic (19, 66, 67); income (66, 68) |
General |
| Proportion of cumulative open vs. Laparoscopic rates of cumulative colorectal surgery for colorectal cancer, diverticular disease, inflammatory bowel disease and benign colorectal tumors | Racial/ethnic (221) | Colon & rectal |
| Proportion of patients undergoing surgery for colorectal cancer who have laparoscopic vs. Open surgery | Income (222) ; insurance (222, 223); geography (223) |
Colon & rectal |
| Proportion of patients undergoing surgery for ulcerative colitis open vs. Laparoscopic surgery | Insurance (224) | General |
| Proportion of patients undergoing a laparoscopic vs. Open surgery appendectomy, gastric fundoplication or gastric bypass | Racial/ethnic (62) | General |
| Proportion of patients undergoing acute surgery, minimally invasive vs. Open for appendectomy or cholecystectomy | Racial/ethnic (65); insurance (65) |
General |
| Rates of laparoscopic vs. Open appendectomies for patients ages between 11 and 18. | Racial/ethnic (225) | Pediatric |
| Proportion of patients undergoing an abdominal aortic aneurysm repair via endovascular vs. Open surgery | Racial/ethnic (226, 227); insurance (226) |
Vascular |
| Proportion of patients undergoing a thoracic aortic repair via thoracic endovascular aortic repair vs. Open surgery | Racial/ethnic (228); | Vascular |
| Proportion of patients presenting with critical limb ischemia from peripheral arterial disease undergoing endovascular or open revascularization vs. Amputation | Racial/ethnic (106, 229); income (106); insurance (106) |
Vascular |
| Proportion of patients receiving a non-traumatic amputation as the transfermoral compared to transtibial position | Income (230); insurance (230); Other- sex (230) |
Orthopedic |
| Proportion of patients with choledocholithiasis receiving ercp vs. Common bile duct exploration | Geography (231) | General |
| Proportion of patients undergoing a radical prostatectomy vs. A minimally invasive radical prostatectomy | Racial/ethnic (232) | Urology |
| Proportion of patients who underwent a breast conserving surgery for breast cancer completing the recommended length of radiation | Insurance (18) ; racial/ethnic (43) |
General |
| Proportion of patients post mastectomy for local-regionally advanced breast cancer receiving local radiotherapy | Geography (233) | General |
| Proportion of patients post endometrial cancer surgery completing the recommended adjuvant radiotherapy/chemotherapy course | Insurance (124) | Gynecologic oncology |
| Proportion of women receiving surgery for ovarian cancer who receive the recommended adjuvant chemotherapy post operatively | Income (160) | Gynecologic oncology |
| Proportion of patients discharged post lower limb trauma admission who receive follow up inpatient care | Insurance (234) | Orthopedic |
| Proportion of patients with cervical cancer who undergo surgery and do not receive the recommended postoperative radiotherapy | Insurance (125) | Gynecologic oncology |
| Proportion of patients who receive a stoma reversal | Racial/ethnic (69) ; insurance (69) ; income (69) |
General |
| Proportion of patients receiving post hospital trauma care | Insurance (235) | General |
| Proportion of people with a colon cancer colectomy who receive the recommended adjuvant chemotherapy | Geography (236) | Colon & rectal |
| Proportion of patients with primary extremity soft tissue sarcoma who receive adjuvant radiation | Racial/ethnic (211) | Orthopedic |
| Proportion of patient who have femoral shaft internal fixation materials removed | Racial/ethnic (70); Income (70) |
Orthopedic |
| Proportion of prelingual patients who receive a cochlear implant undergoing a sequential cochlear implantation on the other side | Insurance (237) | Otolaryngology |
| Proportion of patients who miss a follow up appointment post cochlear implantation | Insurance (237) | Otolaryngology |
| Proportion of patients who fail to arrive at an appointment at a tertiary hand surgery referral center | Insurance (143) | Orthopedic |