(297) Racial and Ethnic Disparities in Failure-to-Rescue After Sepsis in Noncardiac Surgery

Introduction: Although race-based disparities in postoperative sepsis have been previously described, the extent to which hospitals contribute to these disparities is not known. Failure-to-rescue (FTR) measures a hospital’s ability to salvage patients after they develop complications and may better reflect a hospital’s contribution to outcomes than complication rates.

Methods: This study used data from the ACS NSQIP (2018-2021). The association between (1)sepsis, (2)septic shock, (3)FTR after sepsis, and (4)FTR after septic shock and race and ethnicity was evaluated using logistic regression, controlling for patient demographics, comorbidities, and surgical complexity. We did not adjust for comorbidities in the sepsis and septic shock primary analysis to avoid masking the effects of systemic racism.

Results: We analyzed data from 3,983,771 surgical patients. Among these, 1,328,106 patients had inpatient, non-cardiac surgery (mean [SD] age 60.6 [16]); 746,845 (56.2%) were female, 171,774 (12.9%) were Black, 138,457 (10.4%) were Hispanic, and 1,017,875 (76.6%) were White. Black (adjusted OR, 1.29; 95%CI:1.23-1.35, P< 0.001) and Hispanic individuals (aOR, 1.15; 95%CI: 1.09-1.21, P< 0.001) were more likely to develop sepsis, and Black individuals were more likely to develop septic shock (aOR, 1.27; 95%CI: 1.21-1.36; P< 0.001) compared to White individuals. After also controlling for patient comorbidities, Black and Hispanic individuals did not experience higher rates of septic shock compared to White individuals. Black (aOR, 0.71; 95%CI: 0.54—0.95; P=0.01) and Hispanic individuals (aOR, 0.84; 95%CI: 0.61-1.15, P=0.28) did not experience higher rates of FTR after sepsis, or FTR after septic shock [Black:(aOR, 0.93; 95%CI: 0.80-1.08; P=0.34)] [Hispanic:(aOR, 0.88; 95%CI: 0.72-1.06; P=0.17)] compared to White individuals.

Conclusions: Black and Hispanic individuals experienced higher rates of sepsis and septic shock but did not experience higher rates of failure-to-rescue. These findings suggest that, although there are persistent disparities in postoperative sepsis, minoritized individuals who develop sepsis do not receive lower-quality care compared to White individuals. Reducing inequity in surgical care may require efforts to prevent sepsis and reduce the comorbidity burden of minorities.