K. C. Mulhern1, A. A. Gullick1, L. Goss1, J. Richman1, G. D. Kennedy1, H. Chen1, M. S. Morris1, D. I. Chu1 1University Of Alabama at Birmingham,Division Of Gastrointestinal Surgery,Birmingham, Alabama, USA
Introduction: Racial disparities in surgical outcomes exist. Studies in gastric cancer and hepatocellular carcinoma have suggested that Asian-Americans may have improved outcomes; however, no studies have focused on outcomes in Asian-Americans undergoing colorectal surgery for colorectal cancer. We hypothesized that Asian-Americans with colorectal cancer would have improved surgical outcomes in mortality, post-operative complications (POCs), length-of-stay (LOS) and readmissions compared to other races.
Methods: We queried the 2011-2014 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) cohort for all patients who underwent surgery for colorectal cancer and stratified patients by race. Primary outcome was 30-day mortality. Secondary outcomes included POCs, LOS and 30-day readmission. Unadjusted univariate and bivariate comparisons were made. Chi-square and Wilcoxon Rank Sums tests were used to determine differences among categorical and continuous variables, respectively. Stepwise backwards logistic regression analyses and incident rate ratio (IRR) calculations were performed to identify risk factors for disparate outcomes.
Results: Of the 28,283 patients who underwent surgery for colorectal cancer, racial groups were divided into white (84%), African-American (12%), or Asian-American (4%). Asian-Americans were more likely than other racial groups to be of normal weight (53%, p<0.001), not smoke (90%, p<0.001), and have a low ASA score of 1 or 2 (55%, p<0.001). Compared to other racial groups, Asian-Americans were found to have the shortest LOS (5 days, p<0.001) and lower POCs due to ileus (10.3%, p<0.001), respiratory complications (3.1%, p<0.01), and renal complications (0.9%, p<0.001). There were no differences in 30-day mortality (1.5%, p>0.05) or 30-day readmissions (9.3%, p>0.05) (Table 1). On multivariate analyses, Asian-American race remained independently associated with less post-operative ileus (odds ratio [OR] 0.8, 95%-confidence interval [CI] 0.66-0.98) and decreased LOS by 13% as compared to African-Americans (IRR 0.87, p<0.001) and 4% as compared to whites (IRR 0.96, p<0.001).
Conclusion: Asian-Americans undergoing surgery for colorectal cancer have shorter LOS and lower POCs such as ileus when compared to other racial groups. There were no differences in mortality or 30-day readmissions. The mechanism(s) underlying these disparities will require further study, but may be a result of patient, provider, and healthcare system differences.
