Evidence map›Paper›PMID 40032373›Full record

Observational studyBMJ open2025

Patient-surgeon racial and ethnic concordance and outcomes of older adults operated on by California licensed surgeons: an observational study.

Evan Michael Shannon, Mariah B Blegen, E John Orav, Ruixin Li, Keith C Norris, Melinda Maggard-Gibbons, Justin B Dimick, Christian de Virgilio, David Zingmond, Philip Alberti and 1 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Evan Michael ShannonDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA emshannon@mednet.ucla.edu.ORCID http://orcid.org/0000-0003-0248-7038
Mariah B BlegenVA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
E John OravDivision of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Ruixin LiDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Keith C NorrisDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.ORCID http://orcid.org/0000-0003-3071-0700
Melinda Maggard-GibbonsVA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Justin B DimickCenter for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Christian de VirgilioDepartment of Surgery, Harbor-University of California, Los Angeles Medical Center, Torrance, California, USA.
David ZingmondDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Philip AlbertiAssociation of American Medical Colleges, Washington, DC, USA.
Yusuke TsugawaDepartment of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California, USA.ORCID http://orcid.org/0000-0002-1937-4833

Funding

The Impact of Surgeon Factors and Education/Training on Disparities in Surgical Care.R01MD013913 · NIMHD · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI TSUGAWA, YUSUKE · 2020 to 2024
$3.6M
The Impact of physician and health system factors on the quality of care for persons with Alzheimer's disease and related dementias at the end of lifeR01AG068633 · NIA · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI TSUGAWA, YUSUKE · 2020 to 2024
$3.0M
The effect of medical school, residency program, and health system board diversities on racial and ethnic disparities in AD/ADRD care.R01AG082991 · NIA · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI Yusuke Tsugawa · 2023 to 2026
$2.1M
NIA NIH HHS R01 AG068633NIA NIH HHS R01 AG082991NIMHD NIH HHS R01 MD013913
6 · The paper itself

Abstract

objectiveTo examine the association of patient-surgeon racial and ethnic concordance with postoperative outcomes among older adults treated by surgeons with California medical licences.

designRetrospective cohort study.

settingUS acute care and critical access hospitals in 2016-2019.

participants100% Medicare fee-for-service beneficiaries aged 65-99 years who underwent one of 14 common surgical procedures (abdominal aortic aneurysm repair, appendectomy, coronary artery bypass grafting, cholecystectomy, colectomy, cystectomy, hip replacement, hysterectomy, knee replacement, laminectomy, liver resection, lung resection, prostatectomy and thyroidectomy), who were operated on by surgeons with self-reported race and ethnicity (21.4% of surgeons) in the Medical Board of California database. We focused our primary analysis on black and Hispanic beneficiaries. PRIMARY OUTCOMES MEASURE: The outcomes assessed included (1) patient postoperative 30-day mortality, defined as death within 30 days after surgery including during the index hospitalisation, (2) 30-day readmission and (3) length of stay. We adjusted for patient, physician and hospital characteristics.

resultsAmong 1858 black and 4146 Hispanic patients treated by 746 unique surgeons (67 black, 98 Hispanic and 590 white surgeons; includes surgeons who selected multiple backgrounds), 977 (16.3%) patients were treated by a racially or ethnically concordant surgeon. Hispanic patients treated by concordant surgeons had lower 30-day readmission (adjusted readmission rate, 4.2% for concordant vs 6.6% for discordant dyad; adjusted risk difference, -2.4 percentage points (pp); 95% CI, -4.3 to -0.5 pp; p=0.014) and length of stay (adjusted length of stay, 4.1 d vs 4.6 days (d); adjusted difference, -0.5 d; 95% CI, -0.8 to -0.2 d; p=0.003) than those treated by discordant surgeons. We found no evidence that patient-surgeon racial and ethnic concordance was associated with surgical outcomes among black patients or mortality among Hispanic patients.

conclusionsPatient-surgeon racial and ethnic concordance was associated with a lower postoperative readmission rate and length of stay for Hispanic patients. Increasing Hispanic surgeon representation may contribute to narrowing of racial and ethnic disparities in surgical outcomes.

Indexed as

Postoperative ComplicationsSurgeonsSurgical Procedures, OperativeAgedAged, 80 and overBlack or African AmericanCaliforniaEthnicityFemaleHispanic or LatinoHumansLength of StayMaleMedicarePatient ReadmissionRetrospective StudiesHealth EquityHealth WorkforceSURGERY

Identifiers

PMID40032373
PMCPMC11877244

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.