Surgery Can Get Complicated for Minorities

Postsurgical common complications likelier among older black and Hispanic patients

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

Patients considering surgery often have a number of things to consider. With a few kinds of surgery, older ethnic minority patients might have extra considerations that older white patients don't need to worry as much about.

A recent study found that older black and Hispanic patients had a higher chance of developing a number of complications compared to older white patients after having general, vascular or orthopedic surgery.

According to the researchers of the study, older minority patients are often sicker going into surgery and are therefore at greater risk for complications. Based on the findings, the researchers said there's a need to improve surgical safety and quality, especially for older minorities.  

"Talk to your surgeon about all possible risks with surgery."

A study led by J. Carthon, PhD, RN, from the Center for Health Outcomes and Policy Research at the University of Pennsylvania, compared the complications that occurred across three racial and ethnic groups after having surgery. The racial groups consisted of white, black and Hispanic individuals.

About 86 percent of the 587,314 patients involved in the study were white, 6 percent were black and 8 percent were Hispanic.

The patients were over age 65 and treated at 600 non-federal acute care, or short-term care, hospitals in four states between 2006 and 2007.

The hospitals, which were located in California, Pennsylvania, New Jersey and Florida, were linked to the American Hospital Association Annual Survey data and the US Census.

Patients underwent general, vascular or orthopedic surgery. Vascular surgery involves the arteries and veins, while orthopedic surgery involves the musculoskeletal system of the body.

The researchers tracked 13 complications that frequently occur post-operation. These included gastrointestinal bleeding or blood loss, shock, wound infection, sepsis (or blood poisoning), pressure ulcer, internal organ damage and pneumonia.

Other complications included renal dysfunction, respiratory compromise, delirium or psychosis, pneumothorax and cardiac (or heart) emergencies.

They found that black patients had a significantly greater chance of developing 12 of the 13 complications compared to white patients.

For blacks, the chances of developing the 12 complications ranged from a 9 percent increased risk to more than two and a half times greater risk compared to whites.

Hispanic patients were between 11 percent and 82 percent more likely to develop nine of the 13 complications compared to white patients.

At the same time, Hispanics were 16 percent less likely to develop two of the four other complications compared to whites.

"Older black and Hispanic adults experience a disproportionate burden of complications, which has implications for their recovery and quality of life after operative procedures," the researchers wrote in their report. "Although this finding is of clinical importance, of equal significance is the occurrence of lower risk of adverse events in some instances."

The authors noted several limitations with their investigation, including that they could not identify why different ethnicities had varying risks for complications.

They also noted that they could not take certain variables into account that might affect the results, including patients' smoking status, related illnesses and cognitive and functional impairments. 

In addition, older adults who had surgery may differ in basic baseline characteristics from other older adults who did not undergo any surgical procedures.

The hospitals included in the study might also not be representative of other hospitals around the country. This might skew the results, according to the authors.

Based on the findings, future research could look at how risk factors prior to surgery could be modified to serve as protective factors among the three ethnic groups.

Funding for the study was provided by the National Institutes of Health, National Institute of Nursing Research, the Agency for Healthcare Research and Quality and the National Hartford Centers of Gerontological Nursing Excellence Claire M. Fagin Fellowship.

The study was published in the September issue of the Journal of the American Geriatrics Society.

Review Date: 
October 2, 2013
Last Updated:
October 3, 2013