Cancer surgery among American Indians

Abstract

Importance: American Indians (AIs) have the poorest cancer survival rates of any US ethnic group. Late diagnosis, poor access to specialty care, and delays in therapy likely contribute to excess mortality. Surgery plays a central role in therapy for solid organ cancer. Objective: To determine whether operative outcomes also contribute to poor long-term survival among AI patients with cancer. Design: Population-based retrospective cohort study comparing patient- and hospital-level factors and shortterm operative outcomes for AI and non-Hispanic white patients. Survey-weighted multivariate analyses assessed the effect of AI ethnicity on hospital location, inhospital mortality, and prolonged length of stay. Setting: A 20% stratified sample of all US community hospitals. Patients: Patients undergoing oncologic resection for 1 of 20 malignant neoplasms in the Nationwide Inpatient Sample from January 1, 1998, through December 31, 2009. Main Outcome Measure: In-hospital mortality, length of stay, and hospital location (rural vs urban). Results: Of 740 878 patients who met our inclusion criteria, 3048 were AIs. The AI patients were younger, more likely to undergo cancer surgery at rural hospitals, and more likely to be admitted for nonelective procedures and had more comorbidities than non-Hispanic white patients of similar ages (all, P