Black Patients Less Likely to Undergo Surgery at Freestanding Ambulatory Surgery Centers

By Kaitlyn D’Onofrio - Last Updated: September 11, 2020

Black race and public health insurance were associated with lower odds of undergoing surgery at a freestanding ambulatory surgery center (ASC), according to a study.

Care at a freestanding ASC, compared to hospital outpatient departments, tends to cost less, the study authors noted, and while the rate of surgeries being performed in freestanding ASCs is in the rise, “questions remain regarding the existence of disparities among patients receiving care at ASCs.”

To conduct their cohort study, the researchers queried the State Ambulatory Surgery and Services Databases of the Healthcare Cost and Utilization Project to collect data on patients aged between 18 and 89 years treated in New York and Florida between 2011 and 2013. Twelve different types of ambulatory surgical procedures were assessed. The main outcomes were undergoing surgery at a freestanding ASC and 30-day postoperative unplanned hospital visits.

Final analysis included 5.6 million New York patients (68.9% aged ≥50 years; 57.4% were female) and 7.5 million Florida patients (77.4% aged ≥50 years; 57.3% were female) who underwent ambulatory surgery. When adjusting for age, comorbidities, health insurance status, household income, and location and type of surgery, the odds of being treated at a freestanding ASC were, compared to white patients in New York, significantly lower for black (adjusted odds ratio [aOR]=0.82; 95% confidence interval [CI], 0.81 to 0.83; P<0.001) and Hispanic patients in New York (aOR=0.78; 05% CI, 0.77 to 0.79; P<0.001). Black patients in Florida were also less likely than white patients to undergo surgery at a freestanding ASC (aOR=0.65; 95% CI, 0.65 to 0.66; P<0.001). In both states, patients with public health insurance coverage were much less likely to be treated at a freestanding ASC—notably among patients with Medicaid (New York: aOR=0.22; 95% CI, 0.22 to 0.22; P<0.001; Florida: aOR=0.40; 95% CI, 0.40 to 0.41; P<0.001) and Medicare (aOR=0.46; 95% CI, 0.46 to 0.46; P<0.001 and aOR=0.67; 95% CI, 0.66 to 0.67; P<0.001, respectively).

The study was published in JAMA Surgery.

In their conclusion the researchers said it’s important to determine what factors are influential on these disparities to increase access for all populations to receive care at freestanding ASCs.

The authors of an accompanying editorial wrote that the researchers “are to be congratulated on their work, which analyzed the association of socioeconomic status with ambulatory surgery center (ASC) access and outcomes in Florida and New York.”

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