Racial variation in the quality of care among patients undergoing cystectomy for bladder cancer

Abstract

Introduction Differences in quality of care may contribute to racial variation in outcomes of bladder cancer (BC). Quality indicators in BC surgery include use of high-volume surgeons (HVSs) and hospitals (HVHs), receipt of pelvic lymphadenectomy (PLND) and undergoing radical cystectomy (RC) instead of partial cystectomy (PC) when clinically indicated. We compared these quality indicators across racial groups. Methods We used public-access versions of the Healthcare Cost and Utilization Project's State Inpatient Databases, selecting NY, FL, and MD (1996-2007), because they included race, surgeon and hospital identifiers. We identified cases by ICD-9-CM codes. We defined HVS / HVH as top volume decile surgeons / hospitals. Quality indicators were compared across racial groups using mixed-effects models, adjusting for age, Elixhauser comorbidity sum, insurance, and year, with random effects for state. Results There were 16,631 cases, 13,917 (83.7%) RCs and 2,713 (16.3%) PCs. The cohort was 87.0% Caucasian, 5.3% African-American (AA) and 7.8% Other. Compared with Whites, AA patients were younger (65.3 SD [11.6] vs. 69.4 [10.3] years, p Conclusions As indicators of surgical quality among BC patients, utilization of RC compared to PC, and use of PLND, HVSs and HVHs among patients undergoing RC, varied by race. Assuming that these findings do not reflect differences in surgical indications, they may identify a quality gap, which could influence important outcomes.