Date of Award

January 2025

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Michael Alperovich

Abstract

Accurate data collection on race and ethnicity is critical to detecting and characterizing disparities in surgical care. This study explores the prevalence and impact of missing race and ethnicity data in the National Surgical Quality Improvement Project Pediatric (NSQIP Pediatric) database. NSQIP Pediatric from 2016-2020 was assessed for patients who were missing data for race (RM), ethnicity (EM), or both (BM). Changes in proportion of RM, EM, and BM patients were assessed with Cochran-Armitage tests. Surgical outcomes were modeled using linear mixed-effects models, treating CPT codes as random effects. Models were bootstrapped with 1000 iterations for each outcome. Of 596,571 patients, 18.0% were RM, 10.9% were EM, and 8.3% were BM. BM patients increased in proportion from 5.7% in 2016 to 12.1% in 2020 (p < 0.0001). Outcomes which differed statistically significantly were worse in RM than non-RM patients. Multivariate analysis found that BM patients had longer hospital lengths-of-stay than non-BM patients (b = 0.5 days, p < 0.001). BM patients also had higher odds of readmission (OR = 1.22 [1.02-1.46]) and any complication (OR = 1.27 [1.03-1.59]). NSQIP-P exhibits a systematic increase in missing race and ethnicity data that has not been previously described in other literature or database documentation. Controlling for surgery type and patient demographics, patients exhibited worse outcomes with respect to hospital lengths-of-stay and rates of both readmission and any complication. Further work is necessary to determine the cause of this missing data and provide guidance for researchers examining surgical disparities utilizing NSQIP Pediatric.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/14/2026

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