L. Goss1,2, A. Gullick1,2, M. Morris1,2, J. Richman1,2, G. Kennedy1,2, D. Chu1,2 1University Of Alabama at Birmingham,GI Surgery,Birmingham, Alabama, USA 2VA Birmingham HealthCare System,Surgery,Birmingham, AL, USA
Introduction:
Racial disparities in surgical outcomes such as length-of-stay (LOS) exist with African-Americans having worse outcomes compared to other racial/ethnic groups. Surgery for metastatic colorectal cancer (CRC) is associated with poor outcomes and it is unclear if racial disparities exist. We hypothesized that African-Americans undergoing surgery for stage IV CRC would have worse surgical outcomes including longer LOS compared to other racial/ethnic groups.
Methods:
We queried the 2011-2014 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) colectomy procedure targeted cohort for all patients who underwent surgery for stage IV colorectal cancer and stratified patients by race. Our primary outcome was LOS and secondary outcomes include 30-day mortality, 30-day readmission, and post-operative complications. Chi-square and Wilcoxon Rank Sums tests were used to determine differences among categorical and continuous variables, respectively. Stepwise backwards linear regression was performed to identify risk factors for LOS.
Results:
Of the 28,283 patients who underwent colectomy for colorectal cancer, 1,798 (6.4%) had stage IV cancer. Of these stage IV patients, 1,502 (83.5%) were white, 225 (12.5%) were African-American, and 71 (3.9%) were Asian-American. Similarities were seen between races in sex (p=0.86), smoking status (p=0.37), and steroid use (p=0.47). African-Americans were more likely to be on medications for hypertension (53.3%, p=0.04), have diabetes (19.6%, 0.03), and have an open approach (75.1%, p=0.01). African-Americans had a significantly longer post-operative hospital length of stay (7 days) when compared to white patients (6 days, p<0.01). There were no differences in 30-day readmissions or 30-day mortality by race. African-Americans had the highest rates of post-operative complications when compared to white and Asian-Americans including: wound complications (10.7% vs. 8.8% and 7%, p=0.57), sepsis (9.3% vs. 8.6% and 8.5%, p=0.94), respiratory complications (8.9% vs. 5.2% and 4.2%,p=0.07), renal complications (2.2% vs. 1.3% and 1.4%, p=0.52), and urinary tract infection (4.4% vs. 3.5% and 2.8%, p=0.71) but these were not statistically significant. On adjustment for covariate differences, African-American patients still had the longest LOS compared to white patients (p<0.01, Figure 1).
Conclusion:
African-Americans have a significantly longer LOS after colectomy for stage IV CRC compared to other racial/ethnic groups, but no difference in 30-day mortality or readmissions. Higher complications rates were observed in African-Americans although not statistically significant. Further investigations are needed to better understand the mechanisms underlying these disparities.
