Surgeon and hospital factors associated with racial and ethnic disparities in surgical outcomes among persons with AD/ADRD

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Abstract This proposed supplement examines the racial and ethnic (R/E) disparities in surgical outcomes and potential contributing factors—such as surgeon and hospital characteristics—among persons with Alzheimer’s disease and its related dementias (AD/ADRD) who undergo surgery. Due to the aging of the population, it has become increasingly common for persons with AD/ADRD to undergo a surgical procedure, with hip fracture being the most frequent indication. Existing studies have shown that patients from R/E minoritized communities undergoing surgery experience higher mortality, complications, and readmissions than White patients. Similarly, R/E disparities in AD/ADRD care, including the use of medications and long-term services, caregiving, and mortality, are well documented. However, little is known regarding R/E disparities in surgical outcomes among persons with AD/ADRD undergoing surgery. To address this knowledge gap, we will leverage the parent NIMHD project that examines surgeon characteristics associated with R/E disparities in surgical outcomes using a comprehensive dataset consisting of Medicare claims data, the Doximity physician database, the Association of American Medical Colleges Medical School database, and the American Medical Association Residency database. In Aim 1, we will determine whether the R/E disparities in surgical outcomes (e.g., length of stay, complications, 30-day, 90-day, and 1-year operative mortality) differ between surgical patients with AD/ADRD compared to those without AD/ADRD. We hypothesize that R/E disparities in surgical outcomes are exacerbated among persons with AD/ADRD because of their vulnerabilities and challenges with communicating with clinicians effectively, which is an important contributor to disparities. In Aim 2, we will identify surgeon characteristics associated with R/E disparities in surgical outcomes among persons with AD/ADRD. We hypothesize that certain characteristics of surgeons (e.g., age, gender, R/E diversity of medical school and residency program, number of R/E minoritized patients treating) are associated with larger or smaller disparities in surgical outcomes among persons with AD/ADRD. In Aim 3, we will identify hospital characteristics associated with R/E disparities in surgical outcomes among persons with AD/ADRD. We hypothesize that certain hospital characteristics (e.g., teaching status, accountable care organization participation, diversity of board members) are associated with disparities in surgical outcomes among persons with AD/ADRD. We will additionally link the American Hospital Association Hospital database, the American Hospital Association National Health Care Governance Survey data, and the AHRQ Compendium of US Health Systems to obtain hospital characteristics. This project will identify potentially modifiable factors associated with disparities in persons with AD/ADRD who undergo surgery and inform future interventions to reduce disparities in this vulnerable population.