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World Journal of Surgery
Published in: World Journal of Surgery 3/2015

01-03-2015 | Original Scientific Report

Racial Disparities in Operative Outcomes After Major Cancer Surgery in the United States

Authors: Shyam Sukumar, Praful Ravi, Akshay Sood, Mai-Kim Gervais, Jim C. Hu, Simon P. Kim, Mani Menon, Florian Roghmann, Jesse D. Sammon, Maxine Sun, Vincent Q. Trinh, Quoc-Dien Trinh

Published in: World Journal of Surgery | Issue 3/2015

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Abstract

Background

Numerous studies have recorded racial disparities in access to care for major cancers. We investigate contemporary national disparities in the quality of perioperative surgical oncological care using a nationally representative sample of American patients and hypothesize that disparities in the quality of surgical oncological care also exists.

Methods

A retrospective, serial, and cross-sectional analysis of a nationally representative cohort of 3,024,927 patients, undergoing major surgical oncological procedures (colectomy, cystectomy, esophagectomy, gastrectomy, hysterectomy, pneumonectomy, pancreatectomy, and prostatectomy), between 1999 and 2009.

Results

After controlling for multiple factors (including socioeconomic status), Black patients undergoing major surgical oncological procedures were more likely to experience postoperative complications (OR: 1.24; p < 0.001), in-hospital mortality (OR: 1.24; p < 0.001), homologous blood transfusions (OR: 1.52; p < 0.001), and prolonged hospital stay (OR: 1.53; p < 0.001). Specifically, Black patients have higher rates of vascular (OR: 1.24; p < 0.001), wound (OR: 1.10; p = 0.004), gastrointestinal (OR: 1.38; p < 0.001), and infectious complications (OR: 1.29; p < 0.001). Disparities in operative outcomes were particularly remarkable for Black patients undergoing colectomy, prostatectomy, and hysterectomy. Importantly, substantial attenuation of racial disparities was noted for radical cystectomy, lung resection, and pancreatectomy relative to earlier reports. Finally, Hispanic patients experienced no disparities relative to White patients in terms of in-hospital mortality or overall postoperative complications for any of the eight procedures studied.

Conclusions

Considerable racial disparities in operative outcomes exist in the United States for Black patients undergoing major surgical oncological procedures. These findings should direct future health policy efforts in the allocation of resources for the amelioration of persistent disparities in specific procedures.
Appendix
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Metadata
Title
Racial Disparities in Operative Outcomes After Major Cancer Surgery in the United States
Authors
Shyam Sukumar
Praful Ravi
Akshay Sood
Mai-Kim Gervais
Jim C. Hu
Simon P. Kim
Mani Menon
Florian Roghmann
Jesse D. Sammon
Maxine Sun
Vincent Q. Trinh
Quoc-Dien Trinh
Publication date
01-03-2015
Publisher
Springer US
Published in
World Journal of Surgery / Issue 3/2015
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-014-2863-x

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