For years, published reports have documented disparities in the surgical treatment and outcomes of ulcerative colitis (UC) patients who belong to racial and ethnic minorities, as the incidence of the disease among these populations has steadily grown. A new Mount Sinai research project directly challenges, but also partly confirms, these reports.
The issue is important because these disparities—which, while often ill defined, include lower utilization of biologics and immunomodulators and reduced access to minimally invasive surgery compared to white patients—could have significant health implications over the short and long term for people with UC.
“As gastrointestinal specialty providers, we’ve always been concerned that minority patients with less insurance coverage will experience delays in their care or not have access to an expert level of care typically found in multidisciplinary, tertiary inflammatory bowel disease (IBD) centers, including our own Susan and Leonard Feinstein IBD Clinical Center,” acknowledges Patricia Sylla, MD, Chief of Colon and Rectal Surgery for the Mount Sinai Health System.
In an effort to address the issue head on, Dr. Sylla led a comprehensive study to evaluate if there were any racial or ethnic disparities in the surgical management and outcomes of patients undergoing restorative proctocolectomy, or J pouch surgery, at Mount Sinai for severe medically refractory ulcerative colitis. This usually requires three consecutive operations, including removal of the colon, creation of the J pouch, and closure of the protective ileostomy. The first two steps are typically performed through a minimally invasive approach.
Dr. Sylla's research showed equitable surgical care across racial and ethnic groups, but disparities in access to specialized care before reaching the point of surgery.
A smaller cohort of the recently updated Mount Sinai study was reported at the national meeting of the American Society of Colon and Rectal Surgeons (ASCRS) in May 2023, and showed that three-stage restorative proctocolectomy was performed at similar rates in both white and ethnic/racial minority patients (82.3 percent vs. 80.7 percent). More specifically, there were no observable differences in restorative vs. non-restorative pathways, minimally invasive vs. open approaches, or 30-day postoperative complications.
Researchers did notice, however, that minority patients were more likely to present urgently or emergently for their initial colectomy relative to their white counterparts (48.3 percent vs. 34.5 percent), though surgical approach outcomes were comparable between the groups. The Mount Sinai team believes that difference could reflect substandard support networks as well as disparities in insurance status and barriers to referral to our tertiary IBD center, resulting in a delay in expert IBD care. Those same dynamics could account for the finding of a higher proportion of minority patients undergoing restorative procedures with stoma time exceeding six months.
Mount Sinai plans to publish these results on equity in surgical management of UC patients later this year.
“We’re very pleased that our findings provide valuable real-world evidence of equitable surgical care across racial and ethnic groups, while identifying critical areas for improvement, such as ensuring more timely access to specialized care,” says Dr. Sylla, Professor of Surgery (Colon and Rectal Surgery) at the Icahn School of Medicine at Mount Sinai, and senior author of the study. “They clearly showed the impact high-volume IBD centers such as ours with a focus on individualized treatment and collaborative medical care can have. In these settings, patients tend to get referred to surgery much sooner, and any disparities in care are virtually eliminated.”