Abstract B93: Does race predict the likelihood of laparoscopic versus open colorectal cancer resection?

Abstract

Abstract Background: Laparoscopic colorectal surgery has become an acceptable technique in the treatment of colorectal cancer. Recent studies have shown that laparoscopic resection may have lower complication rates than open surgery. This study analyzes if any racial disparity exists between black and white populations for receiving laparoscopic vs. open colorectal surgery and to identify any contributing factors to the choice of the type of surgery in the treatment of colorectal cancer. Methods: Admissions with a diagnosis of colorectal cancer undergoing laparoscopic or open elective colorectal surgery were selected from the 2007 Healthcare Cost & Utilization Project (HCUP) National Inpatient Sample. Chi-square and t-tests were used to assess patient characteristics using demographic information and ICD-9 codes. Multivariate logistic regression was used to analyze independent predictors of laparoscopic approach to colorectal surgery. Results: We identified 12,831 admissions (black n=1411, white n=11,424). Black and white patients were comparable in disease presentation (localized stage 57% vs. 61%) and geographic location (urban 96% vs. 90%). Blacks more often than whites were diagnosed with diabetes (24% vs. 17%), hypertension (64% vs. 53%), obesity (95 vs. 7%) and renal failure (8% vs. 4%) (all p<0.05). Overall, laparoscopic surgery was performed in 738 cases (5.8%) with blacks receiving laparoscopic surgery significantly less (4.5%) than whites (5.9%, p= .028). Laparoscopic compared to open surgery was associated with fewer complications especially in those patients with co-morbidities (20.5% vs. 25.4%), shorter length of stay (6.6 vs. 9 days), lower mortality (0.4% vs. 2.3%), and lower median hospital charges ($38,021.50 vs. $41,444.50) (all p < 0.05). Independent predictors of undergoing laparoscopic resection were white race (OR=1.44, p=0.024), localized disease stage (OR=1.816, p<0.01), teaching hospital (OR=1.57, p0.05). Conclusion: Significant racial disparity exists between black and white populations in use of laparoscopic colorectal surgery in the treatment of cancer. Even though laparoscopic colorectal surgery has a lower complication rate than open surgery for patients with co-morbidities, blacks undergo laparoscopic colorectal surgery less often than whites. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B93.