TY - JOUR
T1 - Decreased Use of Sphincter-Preserving Procedures Among African Americans with Rectal Cancer
AU - Arsoniadis, Elliot G.
AU - Fan, Yunhua
AU - Jarosek, Stephanie
AU - Gaertner, Wolfgang B.
AU - Melton, Genevieve B.
AU - Madoff, Robert D.
AU - Kwaan, Mary R.
N1 - Publisher Copyright:
© 2017, Society of Surgical Oncology.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Background: Improved multimodality rectal cancer treatment has increased the use of sphincter-preserving surgery. This study sought to determine whether African American (AA) patients with rectal cancer receive sphincter-preserving surgery at the same rate as non-AA patients. Methods: The study used the Nationwide Inpatient Sample for years 1998–2012 to compare AA and non-AA patients with rectal cancer undergoing low anterior resection or abdominoperineal resection. The logistic regression model was used to adjust for age, gender, admission type, Elixhauser comorbidity index, and hospital factors such as size, location (urban vs.rural), teaching status, and procedure volume. Results: The search identified 22,697 patients, 1600 of whom were identified as AA. After adjustment for age and gender, the analysis showed that AA patients were less likely to undergo sphincter-preserving surgery than non-AA patients [odds ratio (OR) 0.70; 95% confidence interval (CI) 0.63–0.78; p < 0.0001). After further adjustment for the Elixhauser comorbidity index, admission type, hospital-specific factors, and insurance status, the analysis showed that AA patients still were less likely to undergo sphincter-preserving surgery (OR 0.78; 95% CI 0.70–0.87; p < 0.0001). Although the proportion of non-AA patients undergoing sphincter-preserving surgery increased during the study period (p = 0.0003), this trend was not significant for the AA patients (p = 0.13). Conclusion: In this data analysis, the AA patients with rectal cancer had lower rates of sphincter-preserving surgery than the non-AA patients, even after adjustment for patient- and hospital-specific factors. Further work is required to elucidate why. Eliminating racial disparities in rectal cancer treatment should continue to be a priority for the surgical community.
AB - Background: Improved multimodality rectal cancer treatment has increased the use of sphincter-preserving surgery. This study sought to determine whether African American (AA) patients with rectal cancer receive sphincter-preserving surgery at the same rate as non-AA patients. Methods: The study used the Nationwide Inpatient Sample for years 1998–2012 to compare AA and non-AA patients with rectal cancer undergoing low anterior resection or abdominoperineal resection. The logistic regression model was used to adjust for age, gender, admission type, Elixhauser comorbidity index, and hospital factors such as size, location (urban vs.rural), teaching status, and procedure volume. Results: The search identified 22,697 patients, 1600 of whom were identified as AA. After adjustment for age and gender, the analysis showed that AA patients were less likely to undergo sphincter-preserving surgery than non-AA patients [odds ratio (OR) 0.70; 95% confidence interval (CI) 0.63–0.78; p < 0.0001). After further adjustment for the Elixhauser comorbidity index, admission type, hospital-specific factors, and insurance status, the analysis showed that AA patients still were less likely to undergo sphincter-preserving surgery (OR 0.78; 95% CI 0.70–0.87; p < 0.0001). Although the proportion of non-AA patients undergoing sphincter-preserving surgery increased during the study period (p = 0.0003), this trend was not significant for the AA patients (p = 0.13). Conclusion: In this data analysis, the AA patients with rectal cancer had lower rates of sphincter-preserving surgery than the non-AA patients, even after adjustment for patient- and hospital-specific factors. Further work is required to elucidate why. Eliminating racial disparities in rectal cancer treatment should continue to be a priority for the surgical community.
UR - http://www.scopus.com/inward/record.url?scp=85039856973&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85039856973&partnerID=8YFLogxK
U2 - 10.1245/s10434-017-6306-4
DO - 10.1245/s10434-017-6306-4
M3 - Article
C2 - 29282601
AN - SCOPUS:85039856973
SN - 1068-9265
VL - 25
SP - 720
EP - 728
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 3
ER -