Massachusetts Chapter of the American College of Surgeons

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Racial and Ethnic Disparities in the Surgical Management and Outcomes of Colorectal Cancer in the Non-Elective Setting
Heather M. Grant1,3, Angie M. Rodday3, Janis Breeze3, Michael V. Tirabassi1,4, Mihaela S. Stefan2,5
1Department of Surgery, UMass Medical School, Baystate, Springfield, MA; 2Institute for Healthcare Delivery and Population Science, UMass Medical School, Baystate, Springfield, MA; 3Clinical and Translational Science Institute, Tufts University, Boston, MA; 4Baystate Children’s Hospital, Springfield, MA; 5Department of Medicine, UMass Medical School, Baystate, Springfield, MA

The purpose of this study was to determine if there are racial and ethnic differences in the surgical approach or postoperative outcomes in a limited cohort of individuals undergoing non-elective surgeries.

We performed a retrospective cohort study of adult patients with colorectal cancer undergoing non-elective colorectal surgery using the NSQIP database for the years 2005-2018. Patients with missing race/ethnicity were excluded. We performed logistic regression to compare surgical approach and 30-day postoperative outcomes between four racial and ethnic groups. Multivariable analyses adjusted for patient characteristics and the urgency of the operation. Analyses of postoperative outcomes also adjusted for surgical approach.

12,572 patients met inclusion criteria: 71% were non-Hispanic white(NHW), 15% non-Hispanic black(NHB), 9% Hispanic, and 6% other. Compared to NHW, NHB race was associated with higher odds of an open approach after adjustment(OR=1.11, 95% CI=1.00-1.25), while Hispanic ethnicity was associated with lower odds(OR=0.85, 95% CI=0.74-0.98)(Table). Prior to adjustment, NHB race was also associated with increased odds of a morbidity(OR=1.13, 95% CI=1.02-1.26) or reoperation(OR=1.22, 95% CI=1.00-1.49) within 30 days, but this was non-significant after adjustment. There were no racial or ethnic differences in the odds of 30-day morbidity, mortality, reoperation, or readmission after adjustment. Sensitivity analysis revealed that individuals with missing race/ethnicity were 30% less likely to have an open surgery(OR=0.70, 95% CI=0.63-0.79) and 35% more likely to have a complication(OR=1.35, 95% CI=1.11-1.63).

Although NHB individuals were more likely to undergo an open procedure in the non-elective setting, we did not observe worse postoperative outcomes after adjustment.

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