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Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
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Racial Disparities in 30-Day Outcomes After Colorectal Surgery in an Integrated Healthcare System.

Timothy J Holleran1,2, Michael A Napolitano1,3, Jessica B LaPiano1,2

  • 1Department of Surgery, Veterans Affairs Medical Center, 50 Irving St. NW, Washington, DC, 20422, USA.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|September 28, 2021
PubMed
Summary

Racial disparities in colorectal surgery outcomes persist despite integrated care. African American patients experienced longer hospital stays, and Hispanic patients had more pulmonary complications, indicating a need for further interventions beyond healthcare access.

Keywords:
Colorectal/IBDHealth systems and health services research

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Area of Science:

  • Surgical outcomes research
  • Health services research
  • Health equity

Background:

  • Racial disparities in colorectal surgery outcomes are well-documented in the US.
  • The Veterans Health Administration (VHA) offers integrated healthcare, potentially reducing disparities.
  • This study assesses racial disparities in 30-day colorectal resection outcomes within the VHA.

Purpose of the Study:

  • To evaluate the VHA healthcare system for racial disparities in 30-day outcomes following colorectal resection.
  • To compare outcomes across different racial and ethnic groups within the VHA patient population.

Main Methods:

  • Retrospective review of colon and rectal resections from 2008-2019 using the VHA Surgical Quality Improvement Program database.
  • Patients categorized by race/ethnicity; multivariable analysis used for outcome comparison.
  • Exclusion of cases with unknown, other, or declined race/ethnicity data.

Main Results:

  • 36,969 cases included: 75.5% Caucasian, 18.2% African American, 5.5% Hispanic, 0.8% Native American.
  • No significant differences in overall complications or mortality across racial groups.
  • African American patients had longer mean length of stay (9.7 vs 10.7 days; p<0.001).
  • Hispanic patients showed higher odds of pulmonary complications (aOR 1.39 [1.17-1.64]; p<0.001) compared to Caucasians.

Conclusions:

  • The VHA's integrated care model may mitigate some racial disparities in colorectal surgery outcomes compared to existing literature.
  • Despite integrated care, specific disparities persist, such as longer stays for African Americans and increased pulmonary complications for Hispanics.
  • Further interventions beyond healthcare access are necessary to fully address and eliminate racial disparities in colorectal surgery outcomes.