{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T02:36:46Z","timestamp":1772505406977,"version":"3.50.1"},"reference-count":37,"publisher":"Georg Thieme Verlag KG","issue":"04","license":[{"start":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T00:00:00Z","timestamp":1702944000000},"content-version":"vor","delay-in-days":79,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Surg J (N Y)"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Racial disparities in outcomes among patients in the United States are widely recognized, but disparities in treatment are less commonly understood. This study is intended to identify treatment disparities in delivery of surgery and time to surgery for diagnoses managed by general surgeons\u2014appendicitis, cholecystitis, gallstone pancreatitis, abdominal wall hernias, intestinal obstructions, and viscus perforations.<\/jats:p><jats:p>\n          Methods\u2003The National Inpatient Sample (NIS) was used to estimate and analyze disparities in delivery of surgery, type of surgery received, and timing of surgery. Age-adjusted means were compared by race\/ethnicity and trends in treatment disparities were evaluated from 1993 to 2017. Linear modeling was used to measure trends in treatment and outcome disparities over time. Mediation analysis was performed to estimate contributions of all available factors to treatment differences. Relationships between treatment disparities and disparities in mortality and length of stay were similarly evaluated.<\/jats:p><jats:p>\n          Results\u2003Black patients were less likely to receive surgery for appendicitis, cholecystitis, pancreatitis, and hernias, and more likely to receive surgery for obstructions and perforations. Black patients experienced longer wait times prior to surgery, by 0.15 to 1.9 days, depending on the diagnosis. Mediation analysis demonstrated that these disparities are not attributable to the patient factors available in the NIS, and provided some insight into potential contributors to the observed disparities, such as hospital factors and socioeconomic factors.<\/jats:p><jats:p>\n          Conclusion\u2003Treatment disparities are present even with common indications for surgery, such as appendicitis, cholecystitis, and gallstone pancreatitis. Black patients are less likely to receive surgery with these diagnoses and must wait longer for surgery if it is performed. Surgeons should plan institution-level interventions to measure, explain, and potentially correct treatment disparities.<\/jats:p>","DOI":"10.1055\/s-0043-1777811","type":"journal-article","created":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T23:55:43Z","timestamp":1703030143000},"page":"e123-e134","source":"Crossref","is-referenced-by-count":2,"title":["Inefficiency in Delivery of General Surgery to Black Patients: A National Inpatient Sample Study"],"prefix":"10.1055","volume":"09","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8531-1128","authenticated-orcid":false,"given":"John N.","family":"Bliton","sequence":"additional","affiliation":[{"name":"Department of Surgery, Jamaica Hospital Medical Center, Queens, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,12,19]]},"reference":[{"key":"ref1","volume-title":"Institute of Medicine Committee, Eliminating Racial, Ethnic Disparities in Health Care","year":"2003"},{"issue":"10","key":"ref2","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.2105\/AJPH.2019.305245","article-title":"The myth of innate racial differences between white and black people's bodies: lessons from the 1793 yellow fever epidemic in Philadelphia, Pennsylvania","volume":"109","author":"R A Hogarth","year":"2019","journal-title":"Am J Public Health"},{"issue":"12","key":"ref3","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1097\/ACM.0000000000003496","article-title":"Changing how race is portrayed in medical education: recommendations from medical students","volume":"95","author":"E Nieblas-Bedolla","year":"2020","journal-title":"Acad Med"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1016\/j.jss.2015.09.016","article-title":"From understanding to action: interventions for surgical disparities","volume":"200","author":"B Hisam","year":"2016","journal-title":"J Surg Res"},{"issue":"16","key":"ref5","doi-asserted-by":"crossref","first-page":"1928","DOI":"10.1200\/JCO.2012.47.8412","article-title":"Eliminating racial disparities in colorectal cancer in the real world: it took a village","volume":"31","author":"S S Grubbs","year":"2013","journal-title":"J Clin Oncol"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1158\/1055-9965.EPI-20-0950","article-title":"Understanding racial disparities in gastrointestinal cancer outcomes: lack of surgery contributes to lower survival in African American patients","volume":"30","author":"J N Bliton","year":"2021","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"32","key":"ref7","doi-asserted-by":"crossref","first-page":"5325","DOI":"10.1200\/JCO.2009.22.2455","article-title":"Racial and ethnic disparities in the use of postmastectomy breast reconstruction: results from a population- based study","volume":"27","author":"A K Alderman","year":"2009","journal-title":"J Clin Oncol"},{"issue":"18","key":"ref8","doi-asserted-by":"crossref","first-page":"1956","DOI":"10.1097\/BRS.0b013e3181ab930e","article-title":"Insurance status, geography, race, and ethnicity as predictors of anterior cervical spine surgery rates and in-hospital mortality: an examination of United States trends from 1992 to 2005","volume":"34","author":"H Alosh","year":"2009","journal-title":"Spine"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1097\/MLR.0b013e31815cecd8","article-title":"Age and racial\/ethnic disparities in arthritis-related hip and knee surgeries","volume":"46","author":"D D Dunlop","year":"2008","journal-title":"Med Care"},{"issue":"11","key":"ref10","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1001\/archsurg.2010.213","article-title":"Understanding the racial disparity in the receipt of endovascular abdominal aortic aneurysm repair","volume":"145","author":"N H Osborne","year":"2010","journal-title":"Arch Surg"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/j.jvs.2007.11.072","article-title":"A census-based analysis of racial disparities in lower extremity amputation rates in Northern Illinois, 1987-2004","volume":"47","author":"J Feinglass","year":"2008","journal-title":"J Vasc Surg"},{"issue":"04","key":"ref12","first-page":"79","article-title":"The effects of location and race on the performance of cardiac procedures","volume":"33","author":"M Perryman","year":"2007","journal-title":"J Health Care Finance"},{"issue":"09","key":"ref13","doi-asserted-by":"crossref","first-page":"2301","DOI":"10.1111\/j.1572-0241.2008.01949.x","article-title":"Racial disparities in cholecystectomy rates during hospitalizations for acute gallstone pancreatitis: a national survey","volume":"103","author":"G C Nguyen","year":"2008","journal-title":"Am J Gastroenterol"},{"key":"ref14","volume-title":"HCUP National Inpatient Sample (NIS)"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.jamcollsurg.2012.11.014","article-title":"Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors","volume":"216","author":"A H Haider","year":"2013","journal-title":"J Am Coll Surg"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1037\/1082-989X.7.1.83","article-title":"A comparison of methods to test mediation and other intervening variable effects","volume":"7","author":"D P MacKinnon","year":"2002","journal-title":"Psychol Methods"},{"key":"ref18","volume-title":"Introduction to Mediation, Moderation, and Conditional Process Analysis","author":"A F Hayes","year":"2018","edition":"2nd ed."},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-023-01756-6","article-title":"Effect of Medicaid expansion in reducing racial disparities in early onset colorectal cancer","volume":"\u2022\u2022\u2022","author":"S Rahman","year":"2023","journal-title":"J Racial Ethn Health Disparities"},{"issue":"07","key":"ref20","first-page":"e42457","article-title":"Racial disparities and outcomes of percutaneous coronary interventions in patients above 65 years in America: a systematic review","volume":"15","author":"O O Olanisa","year":"2023","journal-title":"Cureus"},{"issue":"10","key":"ref21","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1093\/jnci\/djad112","article-title":"Medicaid expansion and racial disparity in timely multidisciplinary treatment in muscle invasive bladder cancer","volume":"115","author":"C Jiang","year":"2023","journal-title":"J Natl Cancer Inst"},{"issue":"04","key":"ref22","doi-asserted-by":"crossref","first-page":"430","DOI":"10.4055\/cios20019","article-title":"Racial disparity in time to surgery and complications for hip fracture patients","volume":"12","author":"S K Nayar","year":"2020","journal-title":"Clin Orthop Surg"},{"issue":"01","key":"ref23","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.athoracsur.2017.01.049","article-title":"Socioeconomic status, not race, is associated with reduced survival in esophagectomy patients","volume":"104","author":"L Erhunmwunsee","year":"2017","journal-title":"Ann Thorac Surg"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1146\/annurev.publhealth.29.020907.090852","article-title":"U.S. disparities in health: descriptions, causes, and mechanisms","volume":"29","author":"N E Adler","year":"2008","journal-title":"Annu Rev Public Health"},{"issue":"08","key":"ref25","first-page":"1329","article-title":"Physicians' ethical responsibilities in addressing racial and ethnic healthcare disparities","volume":"98","author":"N Bostick","year":"2006","journal-title":"J Natl Med Assoc"},{"issue":"01","key":"ref26","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/TA.0000000000002270","article-title":"Management of acute appendicitis in adults: a practice management guideline from the Eastern Association for the Surgery of Trauma","volume":"87","author":"A Rushing","year":"2019","journal-title":"J Trauma Acute Care Surg"},{"issue":"01","key":"ref27","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s00534-012-0568-9","article-title":"TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos)","volume":"20","author":"M Yokoe","year":"2013","journal-title":"J Hepatobiliary Pancreat Sci"},{"issue":"02","key":"ref28","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1503\/cjs.015015","article-title":"Clinical practice guideline: management of acute pancreatitis","volume":"59","author":"J A Greenberg","year":"2016","journal-title":"Can J Surg"},{"issue":"02","key":"ref29","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1007\/s00464-016-5011-x","article-title":"Conservative treatment of acute cholecystitis: a systematic review and pooled analysis","volume":"31","author":"C S Loozen","year":"2017","journal-title":"Surg Endosc"},{"issue":"01","key":"ref30","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s13017-020-00306-3","article-title":"Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines","volume":"15","author":"S Di Saverio","year":"2020","journal-title":"World J Emerg Surg"},{"issue":"05","key":"ref31","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1097\/SLA.0000000000001886","article-title":"Early versus delayed cholecystectomy for acute cholecystitis, are the 72\u2009hours still the rule?: a randomized trial","volume":"264","author":"D Roulin","year":"2016","journal-title":"Ann Surg"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s13017-018-0221-2","article-title":"Is early appendectomy in adults diagnosed with acute appendicitis mandatory? A prospective study","volume":"14","author":"S Abu Foul","year":"2019","journal-title":"World J Emerg Surg"},{"issue":"10","key":"ref33","doi-asserted-by":"crossref","first-page":"4562","DOI":"10.1007\/s00464-019-07245-4","article-title":"Delay in emergency hernia surgery is associated with worse outcomes","volume":"34","author":"I L Leeds","year":"2020","journal-title":"Surg Endosc"},{"issue":"03","key":"ref34","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1097\/00005373-199909000-00014","article-title":"Small bowel perforation: is urgent surgery necessary?","volume":"47","author":"J F Fang","year":"1999","journal-title":"J Trauma"},{"issue":"02","key":"ref35","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1177\/000313481307900228","article-title":"\u2018Let's just wait one more day\u2019: impact of timing on surgical outcome in the treatment of adhesion-related small bowel obstruction","volume":"79","author":"S P Joseph","year":"2013","journal-title":"Am Surg"},{"issue":"01","key":"ref36","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1353\/dem.0.0086","article-title":"Last hired, first fired? Black-white unemployment and the business cycle","volume":"47","author":"K A Couch","year":"2010","journal-title":"Demography"},{"issue":"08","key":"ref39","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1097\/SMJ.0b013e31821f99ff","article-title":"Socioeconomic disparities in prostate cancer mortality and the impact of geographic scale","volume":"104","author":"N Wan","year":"2011","journal-title":"South Med J"},{"issue":"18","key":"ref40","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1002\/bdr2.1578","article-title":"The impact of the ICD-9-CM to ICD-10-CM transition on the prevalence of birth defects among infant hospitalizations in the United States","volume":"111","author":"J L Salemi","year":"2019","journal-title":"Birth Defects Res"}],"container-title":["The Surgery Journal"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1777811.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T23:56:06Z","timestamp":1703030166000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1777811"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10]]},"references-count":37,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2023,10,19]]},"published-print":{"date-parts":[[2023,10]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1777811","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2378-5128","2378-5136"],"issn-type":[{"value":"2378-5128","type":"print"},{"value":"2378-5136","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10]]}}}