The Intersection of Race, Ethnicity, and Sex on Postoperative Complications in Otolaryngology.

Abstract

Racial and ethnic patient health disparities are well-documented within surgical specialties; however, an intersectional lens studying the combined impact of multiple identities has not been evaluated in this context. We aim to explore the multiplicative effect of race, ethnicity, and sex on postoperative complications across a variety of otolaryngologic procedures. Cross-sectional analysis of retrospective data. A multi-institutional cohort using National Surgical Quality Improvement Program (NSQIP) data from 2010 to 2021. The 100 most common NSQIP cases conducted by otolaryngologists between 2010 and 2021 were included. Primary outcomes included 30-day surgical complications and medical complications. Propensity-weighted data were fitted to logistic regression models, and pairwise post hoc comparisons were performed for each race and ethnicity contrast within each sex. Of 146,461 patients included in the final analysis, the majority identified as white (82.6%) and non-Hispanic (NH; 92.35%). Black NH males had 2.15 times higher odds of experiencing any complication than Asian NH males (OR = 2.15, 95% confidence interval [CI] [2.05, 2.26], P < .001). White Hispanic males were half as likely to experience complications compared to black Hispanic males (OR = 0.50, 95% CI [0.37, 0.70], P = .002). White Hispanic females were 68% less likely to experience surgical complications compared to black Hispanic females (OR = 0.32, 95% CI [0.23, 0.46], P < .001). We demonstrate that black male patients experience increased adverse surgical outcomes despite accounting for multiple relevant comorbidities. These findings contribute to the growing literature on intersectionality, providing a strong argument for prospective strategies to address inequities of surgical care in otolaryngology.