The surgery literature is filled with reports on racial or gender disparities in quality. However, whether patient demographics are risk factors for complications or death from ambulatory surgical procedures is unknown. This study explores whether racial, age, and gender outcome dispari- ties exist after ambulatory surgeries. Patients stud- ied included adults (>18 years) receiving common ambulatory surgical procedures (N = 3 174 436) in either a freestanding ambulatory surgical center or a hospital-based outpatient department during 1997-2004 in Florida. Results demonstrate that African Americans were at a significantly increased risk for either mortality or unexpected hospitaliza- tion in 4 of the 5 procedures examined, even after controlling for confounders. For women, unexpected hospital admission or mortality was less likely to occur after almost all procedures examined. Thus, many of the racial and gender disparities in the inpatient surgical literature are also observed in the ambulatory setting. More research is needed to deter- mine the source of these disparities. (Am J Med Qual 2007;22:395-401) Keywords: ambulatory surgical procedures; disparities; quality of care; colonoscopy; cataract removal; upper gas- trointestinal endoscopy; arthroscopy; inguinal hernia INTRODUCTION The surgical literature is filled with reports that document racial or gender inequalities in access to care, 1-4 resource utilization and treatment options offered, 5-10 or patient outcomes. 4,11-19 Most of these studies have focused on the inpatient setting. For example, racial disparities were found to exist in renal 11 and lung 12 transplant outcomes, prostate 13 and bladder 7 cancer treatments, and a variety of car- diovascular surgical procedures. 4,14 Many of these inpatient-based studies found that female gender was associated with poorer outcomes as well. 7,12,14 However, some limited evidence suggests that women may fare better after ambulatory surgeries. 15 Overall, however, little is known about whether patient demo- graphics are a risk factor for complications or death from ambulatory surgical procedures. During the past few decades, changes in reim- bursement schemes 16 and breakthroughs in surgi- cal techniques and anesthesiology 17 have increased the number of ambulatory surgical procedures per- formed in the United States. Today, ambulatory surgical procedures make up 60% to 70% of all sur- geries and have seen a 90% increase between 1997 and 2002. 18 395 AUTHORS’ NOTE: Nir Menachemi is associate professor and director, Center on Patient Safety,Askar Chukmaitov is assistant professor, Division of Health Affairs, L. Steven Brown is in the Division of Health Affairs, Charles Saunders is assistant profes- sor, Division of Health Affairs, and Robert G. Brooks is professor and associate dean for Health Affairs, Florida State University College of Medicine, Tallahassee. This study was funded by the Florida Agency for Health Care Administration. The funding agency did not participate in any aspect of this study. The authors have no conflicts of interest to disclose. Corresponding author: Nir Menachemi, Division of Health Affairs, Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL 32306-4300 (e-mail: nir.menachemi@med.fsu.edu). American Journal of Medical Quality, Vol. 22, No. 6, Nov/Dec 2007 DOI: 10.1177/1062860607307996 Copyright © 2007 by the American College of Medical Quality Quality of Care Differs by Patient Characteristics: Outcome Disparities After Ambulatory Surgical Procedures Nir Menachemi, PhD, MPH Askar Chukmaitov, MD, PhD L. Steven Brown, BS Charles Saunders, PhD Robert G. Brooks, MD, MBA © 2007 American College of Medical Quality. All rights reserved. Not for commercial use or unauthorized distribution. at FLORIDA ST UNIV COLLEGE OF MEDICINE on November 15, 2007 http://ajm.sagepub.com Downloaded from