Abstract
BackgroundThe purpose of this study was to examine racial and socio-economic differences in the receipt of laparoscopic or open surgery among patients with colorectal cancer, and to determine if racial and socio-economic differences exist in post-surgical complications, in-hospital mortality and hospital length of stay among patients who received surgery.MethodsWe conducted a cross-sectional analysis of hospitalized patients with a primary diagnosis of colorectal cancer between 2007 and 2011 using data from Nationwide Inpatient Sample. ICD-9 codes were used to capture primary diagnosis, surgical procedures, and health outcomes during hospitalization. We used logistic regression analysis to determine racial and socio-economic predictors of surgery type, post-surgical complications and mortality, and linear regression analysis to assess hospital length of stay.ResultsA total of 122,631 patients were admitted with a primary diagnosis of malignant colorectal cancer between 2007 and 2011. Of these, 17,327 (14.13 %) had laparoscopic surgery, 70,328 (57.35 %) received open surgery, while 34976 (28.52 %) did not receive any surgery. Black (36 %) and Hispanic (34 %) patients were more likely to receive no surgery compared with Whites (27 %) patients. However, among patients that received any surgery, there were no racial differences in which surgery was received (laparoscopic versus open, p = 0.2122), although socio-economic differences remained, with patients from lower residential income areas significantly less likely to receive laparoscopic surgery compared with patients from higher residential income areas (OR: 0.74, 95 % CI: 0.70-0.78). Among patients who received any surgery, Black patients (OR = 1.07, 95 % CI: 1.01-1.13), and patients with Medicare (OR = 1.16, 95 % CI: 1.11-1.22) and Medicaid (OR = 1.15, 95 % CI: 1.07-1.25) insurance experienced significantly higher post-surgical complications, in-hospital mortality (Black OR = 1.18, 95 % CI: 1.00-1.39), and longer hospital stay (Black β = 1.33, 95 % CI: 1.16-1.50) compared with White patients or patients with private insurance.ConclusionRacial and socio-economic differences were observed in the receipt of surgery and surgical outcomes among hospitalized patients with malignant colorectal cancer in the US.
Highlights
The purpose of this study was to examine racial and socio-economic differences in the receipt of laparoscopic or open surgery among patients with colorectal cancer, and to determine if racial and socio-economic differences exist in post-surgical complications, in-hospital mortality and hospital length of stay among patients who received surgery
White patients were older at the time of admission compared with Blacks, Hispanics and Other racial groups, and the majority of Black patients (50.4 %) lived in the lowest residential income areas compared with 22.0 % of White, 36.1 % of Hispanic and 19.7 % of Other races
White patients were more likely to receive laparoscopic or open surgery compared with other racial groups; 26.5 % of Whites received no surgery compared with 36.4 % of Blacks, 33.9 % of Hispanics and 31.3 % of Other racial groups
Summary
The purpose of this study was to examine racial and socio-economic differences in the receipt of laparoscopic or open surgery among patients with colorectal cancer, and to determine if racial and socio-economic differences exist in post-surgical complications, in-hospital mortality and hospital length of stay among patients who received surgery. Despite adjustment for these factors in many studies, BlackWhite differences in colorectal cancer survival have persisted, worsened and are not fully understood [16,17,18]. A major innovation in surgical techniques was the development of laparoscopic colectomy for colon cancer, which is considered a superior alternative to conventional open colectomy based on findings from randomized trials and meta-analyses [28,29,30,31]. These studies have consistently concluded that laparoscopic colectomy is safe, feasible, and associated with many short-term benefits compared with open colectomy. Laparoscopic surgery has been associated with reduction of postoperative pain, length of stay, and early mobilization compared with an open colectomy [29, 32,33,34,35]
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