Race/ethnicity and socio-economic differences in colorectal cancer surgery outcomes: Analysis of the nationwide inpatient sample

Abstract

Background: 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. Methods: We 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. Results: A 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. Conclusion: Racial and socio-economic differences were observed in the receipt of surgery and surgical outcomes among hospitalized patients with malignant colorectal cancer in the US.