Racial Disparities in 30-Day Outcomes Following Foot and Ankle Surgery: Analysis of 96,383 Patients from the NSQIP Database

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Despite increasing attention to healthcare disparities, limited research exists on racial disparities in foot and ankle (F&A) surgery outcomes. This study investigates racial differences in 30-day postoperative complications, readmissions, reoperations, and mortality following F&A surgery. Methods: Among 136,958 F&A operations from 2011-2023 recorded in the American College of Surgeons National Surgical Quality Improvement Program database, 96,383 patients had race data available for analysis. Major complications included cardiac arrest, myocardial infarction, stroke, pulmonary embolism, and death. Minor complications included superficial/deep surgical site infection, urinary tract infection, and pneumonia. Multivariable logistic regression models assessed the association between race and outcomes, adjusting for demographics (age, sex, BMI), comorbidities (diabetes, smoking, COPD, CHF, hypertension, renal disease, cancer), and surgical factors (ASA class, operation time). Odds ratios were calculated with White as reference race. Results: The cohort included White (81.4%), Black (14.1%), Asian (2.6%), American Indian/Alaska Native (0.8%), Native Hawaiian/Pacific Islander (0.2%). Despite Black patients being significantly younger (44.0 vs. 50.8 years, p< 0.001), they had higher odds of any complications (OR=1.147, 95% CI: 1.063-1.237, p< 0.001), major complications (OR=1.237, 95% CI: 1.092-1.402, p< 0.001), and minor complications (OR=1.144, 95% CI: 1.054-1.242, p=0.001). American Indian/Alaska Native patients also experienced higher odds of any complications (OR=1.381, 95% CI: 1.071-1.779, p=0.013) and major complications (OR=1.564, 95% CI: 1.068-2.291, p=0.022). No significant disparities were found in readmissions (p=0.150), return to operating room (p=0.547), or mortality (p=0.594) after risk adjustment. Conclusion: This analysis reveals persistent racial disparities in post-operative complications following F&A surgery, particularly affecting Black and American Indian/Alaska Native patients. While no disparities were found in readmissions, reoperations, or mortality, the higher complication rates in minority populations, despite younger age, highlight the need for targeted interventions to improve surgical outcomes and reduce healthcare disparities. Future research should investigate the underlying causes of these disparities and develop strategies to achieve equitable surgical outcomes.