3030 — Are There Racial Disparities in Surgical Procedure Length in the Veterans Health Administration?

Shimada SL (COE Bedford), Kaafarani H (COE Bedford), Zhao S (COE Bedford), Loveland SA (COE Bedford), Rosen AK (COE Bedford)

Objectives:
Previous research in the Medicare population has documented longer surgery times for African-American patients compared to Whites. Longer procedure times lead to increased costs and may place patients at greater risk. We examined whether there were racial differences in surgical procedure time in Veterans Health Administration (VA) hospitals.

Methods:
We combined patient characteristics from the FY2001 VA Medical SAS Inpatient Dataset with surgical data from the VA National Surgical Quality Improvement Program (NSQIP) data for the same year. Information on hospital teaching status was obtained from the 2001 American Hospital Association Annual Survey. Our sample included general or orthopedic surgery procedures that had a minimum of ten cases (N=22,601 surgeries). To determine whether race was significantly associated with surgical procedure time in VA hospitals, we ran linear regression models controlling for patient age, gender, comorbidities, procedure code, procedure complexity, multiple procedures, transfer/emergent status, hospital teaching status, and degree of involvement/supervision by attending. We separately tested interactions between minority status and teaching status, degree of supervision, and hospital/region.

Results:
Significant predictors of surgical procedure length were procedure type and complexity, multiple procedures, emergent status, hospital teaching status, degree of supervision by attending, and patient characteristics including minority race, age, sex, obesity, recent weight loss, paralysis, drug abuse, and having a solid tumor without metastases. The adjusted mean procedure time was 131.2 minutes for minorities versus 128.4 minutes for White patients (p=0.0132). This difference was no longer statistically significant once we controlled for the hospital or region in which the surgery was performed. There was also a significant interaction between race and region; no interactions were significant between patient race and teaching status or degree of supervision by attending.

Implications:
Unlike the non-VA setting, surgical procedure length is not significantly different for minorities and Whites in the VA. Although a number of patient characteristics are significantly related to surgical procedure length, procedure characteristics and hospital characteristics account for most of the variance in procedure length.

Impacts:
Future analyses should further explore the reasons behind regional and hospital differences in procedure length.