Disparities in Complicated and Uncomplicated Diverticulitis Management

Author(s):
Maria Barahona; Andrew Tran; Allison Gasnick; Justin Brady; Justin Dvorak; Esther Tseng; Vanessa Ho

Background:

Historically, systemic racism has contributed to disparate outcomes in surgical patients.  In operatively managed diverticulitis, patients from minority racial groups are more likely to experience worse outcomes, including morbidity and mortality.  The aim of our study was to examine a propensity matched cohort of complicated and uncomplicated diverticulitis to quantify whether there is a racial disparity in the provision of operative management.

Hypothesis:

After propensity matching, patients from racial minorities would be less likely to receive surgery.

Methods:

We utilized TriNetX, a global federated network providing access to de-identified statistics on electronic health record data from approximately 103 million patients in 70 healthcare organizations.  We studied two cohorts: uncomplicated and complicated diverticulitis.  The main outcome of interest was whether an operation was performed within 30 days of diagnosis.  We performed a propensity score match between operative and non-operative patients, adjusting for the following confounders: age at diagnosis, ethnicity, gender, diabetes, hypertensive disease, ischemic heart disease, cerebrovascular disease, and chronic lower respiratory disease.  We compared the distribution of race among these matched cohorts using chi-squared tests.

Results:

We matched 28,846 pairs of patients with uncomplicated diverticulitis and 10,585 pairs of patients with complicated diverticulitis.  Within the cohort of uncomplcated diverticulitis patients, white patients made up a larger proportion of the operatively managed group (78.5% vs 74.2%, p<0.001), whereas patients who were Black or Asian had more representation in the nonoperative group (9.2% vs 13.7%, p<0.001; 0.58% vs 1.2%, p<0.001, respectively).  This was also true in complicated diverticulitis, where white patients made up a larger proportion of the operatively managed group (80.3% vs 76.7%, p<0.001) and Black patients were skewed towards the nonoperative group (8.5% vs 10.9%, p<0.001).

Conclusions:

We demonstrated racial disparities in the surgical management of complicated and uncomplicated diverticulitis, suggesting that patients of minority race are less likely to be treated with operations.  If only the most severe cases of of diverticulitis in minority patients are being treated with operations, this may explain a higher rate of poor outcomes in these cohorts.