Surgeon volume and disparities in post-operative complications among black men.

Abstract

66 Background: Racial and ethnic disparities related to prostate cancer treatment are well-described. Lower rates of postoperative complications are noted in men who undergo radical prostatectomy (RP) at high-volume centers or by high-volume surgeons. We assessed whether access to high-volume providers might account for ethnic disparities in postoperative complications from RP. Methods: Using a nationally representative dataset of hospital discharge information, the Perspective Database (Premier Inc, Charlotte, NC), we examined all men who underwent RP (ICD9 60.5) between 2003 and 2010. Data were stratified based on patient characteristics (age, race, marital status, insurance status, Charlson Comorbidity Index), hospital characteristics (number of beds, teaching vs. nonteaching, urban vs. rural, and geographic region), surgical approach (robotic vs. nonrobotic), surgeon volume (low [less than 5], intermediate [5 to 24], and high [more than 24]), and complications (based on Clavien classifications I-V), if any. A logistic regression model accounting for clustering & survey weights was constructed to assess the association of surgeon volume & ethnicity on postoperative major complications (i.e., Clavien III-V). Results: In a multivariate model incorporating clinicodemographic and hospital information, black men continued to demonstrate a higher odds for major complication (OR 1.3 [1.02-1.7]). However, when further incorporating surgeon volume to the multivariate model, there was no longer any difference in the odds for a major complication for black men (OR 1.2 [0.97-1.6]). Patients who underwent RP by intermediate-volume surgeons and high-volume surgeons had a lower incidence of postoperative major complications compared to those treated by a low-volume surgeon (OR 0.6 [0.5-0.7] & 0.4 [0.3-0.5], respectively). Compared to white men, the odds of undergoing RP by a high-volume surgeon are lower for black men (OR 0.6 [0.5-0.8]). Conclusions: Our data demonstrate that access to high-volume surgeons may explain the increased odds for postoperative major complications among black men undergoing RP. Further research related to barriers to health care access & further efforts at removing said barriers for black men is warranted.