What happens to racial and ethnic minorities after cancer surgery at american college of surgeons national surgical quality improvement program hospitals?

Helen M. Parsons, Elizabeth B Habermann, Steven C. Stain, Selwyn M. Vickers, Waddah B. Al-Refaie

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background: Inadequate access has contributed to widespread racial disparities in cancer care in the United States. However, the outcomes for racial minorities at quality-seeking hospitals, such as those participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), remain unknown. We hypothesized that operative outcomes for racial and ethnic minority patients after cancer surgery at ACS NSQIP hospitals are comparable with those for white patients. Study Design: Using the 2005-2008 ACS NSQIP data, we identified 38,926 patients who underwent thoracic, abdominal, or pelvic cancer surgery. We used multivariate logistic regression to examine the association between race and ethnicity and short-term (30-day) operative outcomes after cancer surgery. Sensitivity analyses were performed to ensure the relationship remained consistent after stratification by procedure. Results: Nonwhite patients constituted 16.9% of patients treated for cancer surgery in ACS NSQIP hospitals. Although nonwhite patients were more likely to have higher levels of comorbidities and undergo more complex resections (p < 0.05 for all), multivariate analyses demonstrated that these patients were as likely as white patients to have adverse short-term operative outcomes develop after cancer surgery. These results persisted after stratification by extent of surgical procedure. However, black, Hispanic, and American-Indian/Alaskan-Native patients were more likely to experience prolonged length of stay (odds ratio for black vs white patients = 1.33; p < 0.001). Conclusions: Racial and ethnic minority patients who undergo their cancer surgery at ACS NSQIP hospitals have short-term operative outcomes similar to white patients, but they remain hospitalized longer. These findings suggest that access to quality-driven hospitals might ameliorate racial disparities in cancer care and outcomes. Future policies should focus on expanding access to quality-driven surgical facilities as a step toward timely and optimal cancer care.

Original languageEnglish (US)
Pages (from-to)539-547
Number of pages9
JournalJournal of the American College of Surgeons
Volume214
Issue number4
DOIs
StatePublished - Apr 2012
Externally publishedYes

Fingerprint

Quality Improvement
Neoplasms
Surgeons
Pelvic Neoplasms
North American Indians
Population Groups
Hispanic Americans
Comorbidity
Length of Stay
Thorax
Multivariate Analysis
Logistic Models
Odds Ratio

Keywords

  • ACS
  • American College of Surgeons
  • American Society of Anesthesiologists
  • ASA
  • length of stay
  • LOS
  • National Surgical Quality Improvement Program
  • NSQIP
  • odds ratio
  • OR

ASJC Scopus subject areas

  • Surgery

Cite this

What happens to racial and ethnic minorities after cancer surgery at american college of surgeons national surgical quality improvement program hospitals? / Parsons, Helen M.; Habermann, Elizabeth B; Stain, Steven C.; Vickers, Selwyn M.; Al-Refaie, Waddah B.

In: Journal of the American College of Surgeons, Vol. 214, No. 4, 04.2012, p. 539-547.

Research output: Contribution to journalArticle

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abstract = "Background: Inadequate access has contributed to widespread racial disparities in cancer care in the United States. However, the outcomes for racial minorities at quality-seeking hospitals, such as those participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), remain unknown. We hypothesized that operative outcomes for racial and ethnic minority patients after cancer surgery at ACS NSQIP hospitals are comparable with those for white patients. Study Design: Using the 2005-2008 ACS NSQIP data, we identified 38,926 patients who underwent thoracic, abdominal, or pelvic cancer surgery. We used multivariate logistic regression to examine the association between race and ethnicity and short-term (30-day) operative outcomes after cancer surgery. Sensitivity analyses were performed to ensure the relationship remained consistent after stratification by procedure. Results: Nonwhite patients constituted 16.9{\%} of patients treated for cancer surgery in ACS NSQIP hospitals. Although nonwhite patients were more likely to have higher levels of comorbidities and undergo more complex resections (p < 0.05 for all), multivariate analyses demonstrated that these patients were as likely as white patients to have adverse short-term operative outcomes develop after cancer surgery. These results persisted after stratification by extent of surgical procedure. However, black, Hispanic, and American-Indian/Alaskan-Native patients were more likely to experience prolonged length of stay (odds ratio for black vs white patients = 1.33; p < 0.001). Conclusions: Racial and ethnic minority patients who undergo their cancer surgery at ACS NSQIP hospitals have short-term operative outcomes similar to white patients, but they remain hospitalized longer. These findings suggest that access to quality-driven hospitals might ameliorate racial disparities in cancer care and outcomes. Future policies should focus on expanding access to quality-driven surgical facilities as a step toward timely and optimal cancer care.",
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