Racial and Ethnic Differences in the Use of High-Volume Hospitals and Surgeons

Objective: To examine racial/ethnic differences in the use of high-volume hospitals and surgeons for 10 surgical procedures with documented associations between volume and mortality. Design: Cross-sectional regression analysis. Setting: New York City area hospital discharge data, 2001-2004. Patients: Adults from 4 racial/ethnic categories ( white, black, Asian, and Hispanic) who underwent surgery for cancer ( breast, colorectal, gastric, lung, or pancreatic resection), cardiovascular disease ( coronary artery bypass graft, coronary angioplasty, abdominal aortic aneurysm repair, or carotid endarterectomy), or orthopedic conditions ( total hip replacement). Main Outcome Measure: Treatment by a high-volume surgeon at a high-volume hospital. Results: There were 133 821 patients who underwent 1 of the 10 procedures. For 9 of the 10 procedures, black patients were significantly ( P < .05) less likely ( after adjustment for sociodemographic characteristics, insurance type, proximity to high-volume providers, and comorbidities) to be operated on by a high-volume surgeon at a high-volume hospital and more likely to be operated on by a low-volume surgeon at a low-volume hospital. Asian and Hispanic patients, respectively, were significantly less likely to use high-volume surgeons at high-volume hospitals for 5 and 4 of the 10 procedures andmorelikely to use low-volume surgeons at low-volume hospitals for 3 and 5 of the 10 procedures. Conclusions: Minority patients in New York City are doubly disadvantaged in their surgical care; they are substantially less likely to use both high-volume hospitals and surgeons for procedures with an established volume-mortality association. Better information is needed about which providers minority patients have access to and how they select them.