Association of race and 30-day postoperative complications after urologic oncology surgery

We aimed to evaluate the association between race and postoperative complications in patients undergoing urologic cancer surgeries, comparing 30-day outcomes between black and white-identifying patients using propensity score matching.

Adult patients undergoing urologic cancer surgeries from 2015-2019 were identified from the National Surgical Quality Improvement Program database. Black-identifying patients were matched 1:1 with white-identifying patients based on surgical procedure, demographics, and medical history. The primary outcome was 30-day mortality. Secondary outcomes included specific complications, such as unplanned readmission, reintubation, and reoperation; myocardial infarction; renal insufficiency; cardiac arrest; surgical site infections (SSIs) and septic shock. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression.

Among 110 028 patients (mean age 46.8 years; 79.1% male; 12.7% black-identifying), a matched cohort of 28 056 was analyzed. No significant difference in 30-day mortality (OR 1.18, 95% CI 0.86-1.63, p=0.296) was observed. Secondary outcomes showed higher odds of unplanned readmission (OR 1.12, 95% CI 1.02-1.24, p=0.018), reintubation (OR 1.36, 95% CI 1.03-1.81, p=0.032), renal insufficiency (OR 1.84, 95% CI 1.37-2.47, p<0.001), and cardiac arrest (OR 1.49, 95% CI 1.01-2.20, p=0.043), but lower odds of myocardial infarction (OR 0.65, 95% CI 0.43-0.99, p=0.048), superficial SSIs (OR 0.65, 95% CI 0.50-0.85 p=0.001), and septic shock (OR 0.67, 95% CI 0.45-0.98, p=0.041) among black-identifying patients.

While no significant difference in 30-day mortality was observed, black-identifying patients were at an increased risk of several postoperative complications compared to white-identifying patients. These observations warrant further investigations into health equity within urology.