Hospital Quality and Racial Differences in Outcomes After Genitourinary Cancer Surgery

Prior work has demonstrated racial disparities in surgical outcomes for solid organ cancers. We sought to assess the relationship between hospital quality and racial disparities in achievement of textbook outcomes among patients undergoing surgery for prostate, kidney, and bladder cancer.

We used 100% national Medicare Provider Analysis and Review files from 2017 to 2020 to assess textbook outcomes in Patients undergoing bladder (i.e., radical cystectomy), kidney (i.e., radical or partial nephrectomy), and prostate (i.e., radical prostatectomy) surgery for genitourinary malignancies. Our exposure was hospital-level quality, assessed by the predicted to expected ratio of achievement of textbook outcomes, agnostic to social and economic determinants of health. Our main outcome was achievement of textbook outcomes in White and Black patients. We defined the textbook outcome as the absence of in-hospital mortality, mortality within 30 days of surgery, readmission within 30 days of discharge, a postoperative complication, and prolonged length of stay. The secondary outcome was percentage of Black and White patients treated at the highest quality hospitals.

As hospital quality increased, disparities in the receipt of textbook outcome for White and Black patients narrowed. For every 0.1 increment increase in the predicted to expected ratio of hospital quality, Black-White disparities in the odds of achieving textbook outcomes decreased by 5.7% (interaction OR: 1.06; 95% CI 1.01-1.11 p = 0.026). Black patients were less likely to be treated at the highest quality hospitals compared to White patients (45.2% vs. 49.5% p = < 0.001%).

Compared to White patients, Black patients had lower odds of textbook outcomes after surgery for prostate, kidney, and bladder cancer. The racial differences in achieving textbook outcomes were narrowed as hospital quality increased. Black patients were less likely than White patients to be treated at the highest-quality hospitals. Our findings underscore the importance of improved access to high quality care among Black patients.