Racial Disparities in Access to Minimally Invasive Emergency General Surgery.

Importance: Disparities in outcomes for emergency general surgery (EGS) procedures may reflect structural inequities in access and care. Understanding how social and economic determinants contribute to these disparities could help identify opportunities to reduce them. Objective: To assess racial disparities between: (1) surgical setting (elective vs EGS), (2) surgical modality (minimally invasive [MIS] vs open), and (3) clinical outcomes of EGS procedures stratified by modality. Design, Setting, and Participants: Retrospective cohort study using data from Premier Healthcare Database, a national, all-payer hospital discharge dataset, spanning 2016 to 2022. Participants were non-Hispanic Black or non-Hispanic White adult patients undergoing cholecystectomy, inguinal hernia repair, ventral hernia repair, or colorectal resections. Data analysis was performed from March 2025 to February 2026. Exposure: Surgical setting (elective vs EGS) and surgical modality (MIS vs open). Main Outcomes and Measures: The primary outcome was operative setting and modality, analyzed with multivariable logistic regression. Secondary outcomes included length of stay, perioperative complications, 30-day readmission, conversion to open modality, and in-hospital mortality. Propensity score matching was used to compare clinical outcomes between Black and White patients undergoing EGS by surgical modality. Results: Among 2 443 304 procedures, 254 281 (10.4%) were performed on Black patients, 2 189 023 (89.5%) were performed on White patients, 1 231 252 (50.3%) were performed on female patients, and 788 205 (32.3%) were performed emergently. Most patients were aged 45 to 64 years (939 123 patients [38.4%]). Black patients had higher adjusted odds of undergoing emergency vs elective procedures (adjusted odds ratio [aOR], 1.29; 95% CI, 1.28-1.30) and open vs MIS in the emergency setting (aOR, 1.06; 95% CI, 1.03-1.08) compared with White patients. Patients undergoing EGS were more likely to be older, female, Black, publicly insured, have higher comorbidity, live in rural areas, and be treated at nonteaching hospitals. Among MIS procedures, Black patients had higher rates of 30-day readmission, longer lengths of stay, and higher conversion to open surgery. For open surgical procedures, Black patients had longer lengths of stay. Conclusions and Relevance: In this retrospective cohort study, Black patients faced disparities in surgical setting, access to MIS, and outcomes. These inequities highlight the need for targeted, equity-focused interventions to expand access to MIS and improve outcomes across diverse populations.