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Trends in Ambulatory Surgical Center Utilization for Common Hand Procedures by Race and Ethnicity
Troy Amen, MD, MBA
1; Omar Shareef, BS
2; Kaveh Torabian, BS
3; Mitchell Johnson, MD
2; Liimakka Adriana, BS
4; Daniel A Osei, MD
11Hospital for Special Surgery, New York, NY; 2Hospital for Special Surgery, New York City, NY; 3Rush University, Chicago, IL; 4Harvard Medical School, Boston, MA
Introduction: There is limited data on how disparities in hand surgery have evolved alongside the rapid growth of free-standing ambulatory surgical centers (ASCs) and whether restrictive patterns of access to these facilities exist based on various sociodemographic variables such as race and ethnicity. We hypothesized that Black, Hispanic, and Asian/Pacific Islander patients would be less likely to undergo common outpatient hand procedures at both ASCs and hospital-based outpatient departments (HOPD) compared with White patients, but that these disparities would decrease over time.
Methods: A retrospective review using the Healthcare Cost and Utilization Project (HCUP) New York State Ambulatory Database was conducted from 2015-2018. Differences in utilization for four common hand procedures were assessed and trended over time by race and ethnicity for HOPDs and freestanding ASCs. Poisson regressions were used to evaluate utilization and their associations with race/ethnicity after adjustment for age, insurance, socioeconomic status, and comorbidities. New York State population estimates were included as offset values in the regression models.
Results: Black, Hispanic, and Asian/Pacific Islander patients were less likely to undergo all common hand procedures at both ASCs and HOPDs compared to White patients. At ASCs, changes in utilization rates over the study period were relatively uniform among Black, Hispanic, and White patients, leaving persistent disparities in utilization across all procedures (
Ptrend>0.05 for all). Interestingly, disparities among Asian/Pacific Islander lessened over time for distal radius ORIF (
Ptrend=0.004) and TFR (
Ptrend=0.022) relative to White patients. Moreover, at HOPDs, disparities in utilization relative to White patients decreased among both Black and Hispanic patients for endoscopic CTR (
Ptrend <0.002 for both) and TFR (
Ptrend=.0.043 for Black).
Discussion: In this study, Black, Hispanic, and Asian patients were less likely to undergo all common hand procedures at both ASCs and HOPDs. Furthermore, we found that these disparities did not improve over time and persisted over the entire study period for minority patients receiving surgery at ASCs. Encouragingly, however, there were improvements in HOPD utilization for Black and Hispanic patients in both endoscopic CTR and TFR. To our knowledge, this is the first study in hand surgery to investigate disparities in ASC utilization and provide a nuanced breakdown of where disparities in the hand surgery delivery model may be arising. Additional research is needed to better understand the forces and policies which may be shaping ASC utilization and the referral patterns for patients who are receiving care at these free-standing high-volume surgical centers.
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