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

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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.

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Acknowledgments

Quoc-Dien Trinh and Shyam Sukumar had full access to all of the data in the manuscript and take responsibility for the integrity of the data and accuracy of the data analysis.

Disclosures

None.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Urology, University of Minnesota, Minneapolis, MN, USA

    Shyam Sukumar

  2. Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK

    Praful Ravi

  3. Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA

    Akshay Sood, Mani Menon & Jesse D. Sammon

  4. Division of General Surgery, University of Montreal Health Center, Montreal, Canada

    Mai-Kim Gervais

  5. Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Jim C. Hu

  6. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada

    Florian Roghmann, Maxine Sun & Vincent Q. Trinh

  7. Department of Urology, Yale University, New Haven, CT, USA

    Simon P. Kim

  8. Division of Urologic Oncology and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, 45 Francis Street ASB II – 3, Boston, MA, 02115, USA

    Quoc-Dien Trinh

Authors
  1. Shyam Sukumar
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  2. Praful Ravi
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  5. Jim C. Hu
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  7. Mani Menon
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  8. Florian Roghmann
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  9. Jesse D. Sammon
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  10. Maxine Sun
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  11. Vincent Q. Trinh
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  12. Quoc-Dien Trinh
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Corresponding author

Correspondence to Quoc-Dien Trinh.

Additional information

Shyam Sukumar, Praful Ravi and Akshay Sood have contributed equally to this work.

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Sukumar, S., Ravi, P., Sood, A. et al. Racial Disparities in Operative Outcomes After Major Cancer Surgery in the United States. World J Surg 39, 634–643 (2015). https://doi.org/10.1007/s00268-014-2863-x

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  • DOI: https://doi.org/10.1007/s00268-014-2863-x

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