Factors affecting outcomes after radical cystectomy in African Americans

BACKGROUND. Previous studies indicate that African Americans with bladder cancer have a worse outcome than Caucasians. Delay in seeking care and higher stage at presentation have been cited as possible reasons for the observed differences. The authors hypothesized that differences in hospital volume where patients undergo radical cystectomy may be responsible for race-based differences in outcomes after the procedure. METHODS. The authors analyzed data from the Health Care Cost and Utilization Project and identified 4862 patients who had undergone radical cystectomy between 1998 and 2002. In-hospital mortality, complications, and length of stay (LOS) in hospital were compared between patients grouped by race. Hospitals were categorized into tertiles by the average number of radical cystectomies performed per year (1-4 radical cystectomies, 5-10 radical cystectomies, and >10 radical cystectomies). Univariate and multivariate analyses were performed to determine predictors of mortality, complications, LOS, and the likelihood that patients would undergo cystectomy at a high/medium-volume hospital. RESULTS. African Americans had the highest in-patient mortality, complications, and LOS after radical cystectomy. They also were the least likely to undergo radical cystectomy at a high/medium-volume hospital. When the analyses were controlled for potential confounding factors, there was no difference in in-hospital mortality by race, but differences persisted in the other 3 outcome variables. African Americans had higher odds of complications (odds ratio [OR], 1.57; P = .001), longer LOS (25%; P = .001), and lower odds of undergoing cystectomy at a high/medium-volume hospital (OR, 0.74; P = .03) compared with Caucasians. CONCLUSIONS. Race was an important factor in determining outcomes after radical cystectomy for bladder cancer. African Americans were less likely to undergo cystectomy at a high-volume hospital, thereby placing them at a higher risk of postoperative complications which ultimately may affect their survival.