• Whitney P Witt, Rosanna M Coffey, Lorena Lopez-Gonzalez, Marguerite L Barrett, Brian J Moore, Roxanne M Andrews, and Raynard E Washington.
• Maternal and Child Health Research, Truven Health Analytics, Inc., 4819 Emperor Boulevard, Suite 125, Durham, NC 27703.
• Health Serv Res. 2017 Feb 1; 52 (1): 220-243.

ObjectiveTo examine the role of patient, hospital, and community characteristics on racial and ethnic disparities in in-hospital postsurgical complications.Data SourcesHealthcare Cost and Utilization Project, 2011 State Inpatient Databases; American Hospital Association Annual Survey of Hospitals; Area Health Resources Files; Centers for Medicare & Medicaid Services Hospital Compare database.MethodsNonlinear hierarchical modeling was conducted to examine the odds of patients experiencing any in-hospital postsurgical complication, as defined by Agency for Healthcare Research and Quality Patient Safety Indicators.Principal FindingsA total of 5,474,067 inpatient surgical discharges were assessed using multivariable logistic regression. Clinical risk, payer coverage, and community-level characteristics (especially income) completely attenuated the effect of race on the odds of postsurgical complications. Patients without private insurance were 30 to 50 percent more likely to have a complication; patients from low-income communities were nearly 12 percent more likely to experience a complication. Private, not-for-profit hospitals in small metropolitan or micropolitan areas and higher nurse-to-patient ratios led to fewer postsurgical complications.ConclusionsRace does not appear to be an important determinant of in-hospital postsurgical complications, but insurance and community characteristics have an effect. A population-based approach that includes improving the socioeconomic context may help reduce disparities in these outcomes.© Health Research and Educational Trust.

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