Disparities in the Utilization of High-Volume Hospitals for Complex Surgery

Referring patients to hospitals that perform high volumes of specific surgical procedures has been associated with better outcomes for those surgical procedures. Less is known about the patient characteristics of those who receive care at low- and high-volume hospitals. This study uses California's Office of Statewide Health Planning and Development patient discharge database to identify patient characteristics associated with the use of high-volume hospitals. Patient race/ethnicity and insurance status were analyzed for 10 surgical procedures between 2000 and 2004: elective abdominal aortic aneurysm repair, coronary artery bypass grafting, carotid endarterectomy, esophageal cancer resection, hip fracture repair, lung cancer resection, cardiac valve replacement, coronary angioplasty, pancreatic cancer resection and total knee replacement.

Key Findings:

  • There were 719,608 patients who received one of the 10 surgical procedures.
  • African Americans were significantly less likely than Caucasians to receive care at high-volume hospitals for six of the 10 operations. Asians were significantly less likely to receive care at high-volume hospitals for five out of 10 procedures and Hispanics for nine out of 10 procedures.
  • Medicaid patients were significantly less likely than Medicare patients to receive care at high-volume hospitals for seven of the operations, while uninsured patients were less likely to be treated at high volume hospitals for nine of the procedures.