For a study, researchers sought to determine if a higher prevalence of severe diabetes mellitus and high blood pressure are factors in the undesirable postoperative discharge of patients of the Black race to a nursing home. Uncertainty exists on whether a patient’s race predicts unfavorable post-operative nursing home discharge and whether pre-existing illnesses have a role. Included were 368,360 adult patients who underwent surgery between 2007 and 2020 in 2  academic hospital networks in New England. Patients who self-identified as White or Black were contrasted. The main result was postoperative release to a nursing home. The effects of severe pre-existing hypertension and diabetes on the primary association were investigated using mediation analysis. Overall, 26,434 (7.2%) patients were sent to a nursing home, while 38,010 (368,360) patients, or 10.3%, were Black. Following surgery, black patients had a higher probability of being discharged to a nursing home (adjusted absolute risk difference: 1.9%; 95% CI: 1.6%-2.2%; P<0.001). In Black patients, significant preexisting diabetes mellitus and hypertension were more common, accounting for 30.2% and 15.6% of the association. Patients with severe hypertension or diabetes mellitus who received preoperative medication-based treatment according to guidelines reduced the primary connection (P for interaction<0.001). For the endpoint 30-day readmission, the same pattern of pharmacotherapy impact reduction was seen. The black race was associated with postoperative discharge to a nursing facility compared to the White race. Optimized preoperative assessment and treatment of diabetes mellitus and hypertension improves surgical outcomes and provides an opportunity for the surgeon to help eliminate healthcare disparities.

Source: journals.lww.com/annalsofsurgery/Abstract/2022/09000/Preoperative_Treatment_of_Severe_Diabetes_Mellitus.20.aspx