Race and Ethnicity Data Missingness in Hepatobiliary and Pancreatic Surgery: Prevalence and Outcomes

Amir Ebadinejad; Sophia Xiao; Ashrita Raghuram; Hassan Aziz

doi:10.1016/j.gassur.2025.102243

Racial and ethnic disparities in surgical outcomes are well-documented across various specialties, including hepatopancreatobiliary (HPB) surgery. While efforts to address these inequities have expanded, an underexplored issue is the growing prevalence of missing race and ethnicity data in national surgical registries such as the ACS NSQIP. This study aimed to evaluate the prevalence of missing race and ethnicity data in HPB procedures within NSQIP and to determine whether such missingness is associated with adverse postoperative outcomes. We performed a retrospective analysis of the American College of Surgeons NSQIP database from 2019 to 2023, identifying patients who underwent HPB procedures. Patients were stratified into three groups based on the completeness of their demographic data: (1) Race known vs. race missing (RM), (2) Ethnicity known vs. ethnicity missing (EM), and (3) race or ethnicity known vs. both missing (BM). Primary outcomes included any postoperative complication, unplanned reoperation, and 30-day mortality. Multivariable logistic regression models were used to assess associations between BM status and adverse outcomes, adjusting for relevant demographic and procedural covariates. Among 72,069 patients who underwent HPB procedures, pancreatic procedures were most common (50.3%), followed by liver (47.7%), and bile duct procedures (2.0%). Of the total cohort, 18.2% (n = 13,106) were classified as RM, 15.6% (n = 11,256) as EM, and 14.2% (n = 10,256) as BM. Over the study period, the proportion of BM patients remained relatively stable, ranging from 18.5% to 23.5%. Patients in the BM group were slightly older (mean age: 63.5 vs. 62.3 years, p < 0.001) and had a lower BMI (27.5 vs. 28.2, p < 0.001) compared to those with complete or partial data. Patients in the BM group had greater unadjusted rates of complications (42.9% vs. 38.1%, p < 0.001), unplanned reoperation (5.0% vs. 3.8%, p <0.001), or mortality (2.0% vs. 1.7%, p = 0.053). On multivariable analysis, BM status was associated with increased odds of postoperative complications (OR: 1.341, 95% CI: 1.283-1.402, p < 0.001), unplanned reoperation (OR: 1.403, 95% CI: 1.268-1.522, p < 0.001) and mortality (OR: 1.194, 95% CI: 1.019-1.400, p = 0.029). A substantial proportion of HPB procedures in the NSQIP database are affected by missing race and ethnicity data, with the prevalence of BM remaining consistent over the study period. The BM group demonstrated distinct clinical and demographic characteristics. While unadjusted outcomes appeared favorable, BM status was independently associated with higher odds of complications, unplanned reoperation, and mortality. These findings suggest the need for further investigation into the underlying causes of missing demographic data and emphasize the importance of addressing data missingness in efforts to promote health equity in surgical care.

Race and Ethnicity Data Missingness in Hepatobiliary and Pancreatic Surgery: Prevalence and Outcomes

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